CareWell Searchable Formulary
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2018 Tier 1 Formulary
We cover both brand name drugs and generic drugs. Generic drugs have the same active-ingredient formula as a brand name drug. Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.
What is a Formulary?
A formulary is a list of covered drugs which represents the prescription therapies believed to be a necessary part of a quality treatment program. We will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a network pharmacy, and other plan rules are followed. For more information on how to fill your prescriptions, please review your Evidence of Coverage.
How to Search For Drugs
How to Request an Exception
You can ask us to make an exception to our coverage rules. There are several types of exceptions that you can ask us to make:
You should contact us to assist you requesting an initial coverage decision for a formulary, tiering or utilization restriction exception. When you are requesting a formulary, tiering or utilization restriction exception you should submit a statement from your physician supporting your request to EnvisonRx Options, Inc. Attn: Coverage Determinations. 2181 East Aurora Road., Suite 201. Twinsburg, OH 44087. Or you and your provider can call 1-844-782-7670 TTY 1-800-662-1220.
Generally, we must make our decision within 72 hours of getting your prescribing physician’s supporting statement. You can request an expedited (fast) exception if you or your doctor believe that your health could be seriously harmed by waiting up to 72 hours for a decision. If your fast request is granted, we must give you a decision no later than 24 hours after we get your prescribing physician’s supporting statement.
A Medicare-approved Part D sponsor