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Tribal Employees: Important Notice Regarding Your Prescription Drug Insurance
1/6/2017 4:00:00 PM - Human Resources


To Our Respected Plan Participates,


Important Notice Regarding Your Prescription Drug Insurance:


If you are currently taking a medication that requires prior authorization please pay close attention to the information below or you may have delays in refilling your prescription.  A list of drugs requiring prior authorization can be obtained from you HR department or by contacting  Scrip World, powered by OptumRx, Customer Service 1-855-312-6103


What Is Prior Authorization?


Some medications must be authorized for coverage because they’re only approved or effective in treating specific illnesses, they cost more or they may be prescribed for conditions for which safety and effectiveness have not been well-established.


Reviewing Medications


Our review committee of independent doctors and pharmacists meets regularly to review medications and consider how they should be covered by pharmacy benefit plans. They also recommend prior authorization guidelines.


Safe and Effective


When making recommendations, the review committee focuses on proven medication safety, effectiveness and cost. The committee considers:


·         U.S. Food and Drug Administration (FDA) approved indications

·         Manufacturer’s package labeling instructions

·         Well-accepted and/or published clinical recommendations


Getting a Short-Term Supply


If you must start taking a medication that requires prior authorization right away, two options may be available to you. First, ask your doctor if a sample is available. If not, check with your pharmacy to request a short-term supply of five days or less — keep in mind you will be responsible for the full cost at that time. If the prior authorization request is approved, then your pharmacist can dispense the rest of your prescription.


Requesting a Prior Authorization


You, your pharmacist or your doctor can start the prior authorization review process by contacting our prior authorization department. A pharmacy technician then works with your doctor to get the information needed for the review. Once we receive a completed prior authorization form from your doctor, we conduct a clinical review within two business days. We then send you and your doctor a letter regarding the prior authorization decision.

Important Contact Information


Scrip World, powered by OptumRx, Customer Service 1-855-312-6103.

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