Pharmacy Updates
Dean Health Plan (DHP) has a document called a
formulary that lists all covered medications and their
corresponding tier level. The document is long, but
you can search it easily by using the search feature in the
toolbar. To search the online list of DHP formulary drugs,
go to deancare.com/drugformulary.
The Pharmacy Information Website has two additional lists
that may be viewed online: the Drug Prior-Authorization
List with Drugs Restricted to Certain Specialists, and the Drug
Exclusion List. You can also call our Customer Care Center at
800-279-1301 to request a complete copy
of either list or for more information about your prescription
drug benefit.
Drug Prior-Authorization List (PA)
The medications on this list require prior authorization (PA)
by DHP. Brand names are listed first with the generic name
in parentheses.
Added to PA List
VIMPAT (lacosamide)
SAVELLA (milnacipran)
ACIPHEX (rabeprazole sodium)
Removed from PA List
None
Drugs Restricted to Certain Specialists (RS)
The drugs on this list are covered only when prescribed by
the specific specialties. Submission of prior authorization is
not required for the specialties indicated. These drugs are not
available for all other specialties.
Added to RS List
None
Removed from RS List
None
As drugs are approved by the U.S. Food and Drug
Administration, we may add them to the above list. Your
physician or your pharmacist should fill out a Drug Prior
Authorization Request Form. For urgent authorizations, your
physician should call Customer Service.
Drug Exclusion List (DE)
Our drug benefit does not automatically cover every new drug
that the U.S. Food and Drug Administration approves. We have
a panel of physicians from many different specialties to
evaluate new drugs. If an excluded drug has been prescribed
for you, ask your physician or pharmacist if he or she can
substitute it with one of the medications we cover. Brand
names are listed first with the generic name in parentheses.
Added to DE List
AMPHETAMINE ER
Removed from DE List
None
General Exclusions:
Non-prescription over-the counter (OTC) drugs, weight loss products,
drugs for cosmetic use, and oral medications for the treatment of sexual
dysfunction.
Please note:
Some members may have coverage for one of these drugs based on an
exception in their pharmacy benefit or an authorization from DHP.
Please note that no changes have been made to any brand-name
ADDERALL XR products.
Drugs on Step Therapy List
ACIPHEX (Failure of omeprazole, Protonix and Kapidex)
ACTONEL (Failure of alendronate)
BONIVA (Failure of alendronate and Actonel)
FLOMAX (Failure of Uroxatrol)
KAPIDEX (Failure of omeprazole cap)
LUVOX CR (Failure of sertraline, fluoxetine, citalopram, paroxetine, or
fluvoxamine)
PRISTIQ (Failure of sertraline, fluoxetine, citalopram, paroxetine, or
fluvoxamine)
ULORIC (Failure of allopurinol)
PROTONIX (Failure of omeprazole cap)
Navigating Health Care Made Easier-
Get Help Scheduling a Specialty Care Visit
 Don't know where to go next?
At the Dean/St.Mary's Regional
Clinic sites there are staff
members that serve as dedicated
referral advocates. When you
need to see a specialist, the
advocate coordinates every step
of the referral process to meet
your needs. When possible,
the advocate will schedule the
appointment before you leave the
clinic. Following the specialty care
visit, your advocate will document
the referral at the primary care
site. This program is designed to
help you get more out of your
specialty care visit and help you
understand your appointment
details.
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