Your Prescription Benefit Program
Welcome to Magellan Rx Management
Magellan Rx Management provides a wide range of prescription benefit programs
that emphasize quality and cost-effective healthcare solutions, driven to improve
overall health. We're pleased to welcome you to your prescription benefit program.
To fill your prescription needs, we offer more than 64,000 pharmacies, representing
major chain regional pharmacies and independent stores. To locate a pharmacy,
you can visit our website at magellanrx.com
or contact one of our Customer
Service agents at 1-800-424-5828.
Please present your identification card along with your prescription to any
participating pharmacy to receive your medication. If you have any questions
regarding your prescription benefit program, please call Magellan Rx
Management Customer Service at 1-800-424-5828.
We are open 24 hours a
day, 7 days a week.
An Introduction to Your
Prescription Benefit Program
Your prescription benefit program is designed to help you and your eligible depen-
dents obtain prescription medications conveniently and at reasonable prices. We
are committed to:
• Providing a quality prescription benefit program that meets your needs and
the needs of your family.
• Promoting the use of safe, cost-effective and clinically appropriate
• Helping you save money and providing convenient access to your
• Helping you achieve the best possible health outcomes.
This booklet is an important resource — along with the Magellan Rx Management
and our Customer Service Department at 1-800-424-5828
We encourage you to review this booklet and visit our website to educate yourself
about your prescription benefit program. Understanding how your program works
will help you get the most out of your benefit.
Maximizing Your Benefits
There are now many generic products available to you on the market. Generic
medications provide quality, cost-effective alternatives to brand medications. One
or more of your prescriptions may be filled with a pharmaceutically equivalent
generic product. We use generic equivalents, whenever possible, in order to reduce
costs to you, your Plan and the health care system — unless otherwise directed by
your physician. These medications have met the standards established by the Food
and Drug Administration (FDA). The FDA approves a generic equivalent if its safety,
purity, strength and effectiveness are proven to match that of the brand-name
product. Please refer to the label on your prescription container to determine if you
have received a generic equivalent.
In general, most plans require the use of generically equivalent products to obtain savings for their members. You may request a brand-name medication by notifying us on your prescription order. The brand-name product may be subject to a higher cost or copay as determined by your Plan.
Over-the-Counter (OTC) ProductsSome brand-name drugs previously available by prescription-only are now available over-the-counter (OTC). For example, drugs such as Claritin®, Prevacid® 24HR, Prilosec OTC®, and Zyrtec® no longer require a prescription and are the same strength as their prescription versions. These OTC products may represent a reasonable therapeutic alternative to other medications in the same class of drugs that still require a prescription. In consultation with your physician, consider an OTC product as it may be a lower cost option to treat your condition. If your Plan provides OTC coverage, you may be eligible for additional benefits.
Health Tools and Information are Just a Click Away
Our website, magellanrx.com
, is a fast, easy, and secure way for you to compare
medication pricing, review prescription benefits in real time, manage your
prescription benefit and more-any time of the day or night. This new tool is part
of our continued effort to be your "one-stop" shop for all of your healthcare and
prescription drug needs.
Online tools available at magellanrx.com
include: Prescription History, Find a
Pharmacy, Drug Information, Drug List, Member Health Education, Drug Pricing Tool,
and Medication Reminder.
The Mail Order Pharmacy makes ordering maintenance medications easy and can
save you both time and money compared to a retail pharmacy. Using your mail
order benefit may enable you to receive up to a 90-day supply at a discounted
price. Plus, shipping is at no cost to you — so you do not have to drive to your
Mail service benefits include:
• Convenient door-to-door service
Taking Your Medications As Directed
Taking medications exactly as prescribed is one of the most important things
you can do to enhance your health and prevent medical complications. Missing
doses, stopping medication early or swapping medications with other people
can lead to serious problems.
Here are a few tips to help you get the greatest benefit from your medications:
• Read labels carefully before taking each medication.
• Ask your physician or pharmacist what to do if you miss a dose.
• Take each medication as prescribed by your physician. For example, take the
correct number of doses each day, at the correct time of day.
• Talk to your physician or pharmacist before you stop taking a medication.
Do not stop taking a medication just because you feel better.
• Talk to your physician or pharmacist before crushing or splitting tablets;
some medications need to be swallowed whole.
• Keep a record of all your current medications, including their names and
regimens (dose, time and other instructions).
• Write down any problems you have with your medications, and discuss them
with your physician or pharmacist.
• Keep medications away from heat, light and moisture. Never store
medications in the bathroom.
• Make taking your medications a part of your daily schedule.
• Properly discard all outdated medications. Call Customer Service, visit
or review FDA guidelines* for information on how to
properly discard your outdated medications.
*Food and Drug Administration, "How to Dispose of Unused Medicines," October 2009.
Magellan Rx Management Formulary
A Prescription Drug List, or formulary, is a list of brand-name and generic
medications that have undergone a careful review by a committee of practicing
physicians and pharmacists. This committee reviews new and existing medications
for safety and efficacy, and decides which medications provide quality treatment at
the best value.
The formulary is updated several times a year as new medications become
available and is subject to change. For the most up-to-date information, or for a full
formulary listing, visit magellanrx.com
While the formulary is intended to provide a comprehensive coverage of your prescription medication needs, there are some products that are not covered or have limited availability. For medications that are not on the formulary or are not covered by your prescription benefit program, talk to your physician about alternative medications.
How Can I Find Out What Medications are On My
The Magellan Rx Management Prescription Drug List is updated several times every
year as new medications become available. The list is subject to change. For the
most up-to-date information, visit magellanrx.com
or call Customer Service at 1-800-424-5828.
For specific coverage and limitations information, as well as details about your copay, please refer to your benefit plan documents.
Magellan Rx Management
Quick Reference Formulary
Most Commonly Prescribed Medications
All generic medications are listed on the Magellan Rx Management standard
formulary. Please use this quick reference list when you receive a prescription.
To receive maximum prescription drug benefits, ask your doctor to prescribe a
medication on this formulary. Remember, if a preferred drug from the formulary
is prescribed, your copay may be less than if a non-preferred drug is prescribed
for you. To see the complete Magellan Rx Management standard formulary, visit magellanrx.com
, or call toll-free 1-800-424-5828.
Drugs are listed alphabetically by brand name.
= (generics)Middle Copay
= Preferred BrandHighest Copay
= Non-Preferred Brand*
Astelin* (azelastine HCL)
Accu-Chek: Aviva Plus,
Astepro* (azelastine hcl
Accu-Chek Kit Fast Clix
ApexiCon E Cream*
ActoPlus Met (piogli-
Alphagan P* (brimoni-
Diovan HCT (valsartan
Inderal LA* (propranolol
Calan, SR* (verapamil, SR) Divigel
Duac* (benzoyl peroxide- Indocin, SR* (indometha- clindamycin)
Isoptin, SR* (verapamil,
Effexor XR* (venlafaxine
Janumet, Janumet XR
Climara* (estradiol patch)
Evista* (raloxifene hcl)
Glucophage, XR* (metfor- Lipitor* (atorvastatin)
Glucotrol, XL* (glipizide)
Detrol, LA* (tolerodine)
Lotensin, HCT* (benaz-
Dilacor XR* (diltiazem CR)
Hyzaar* (losartan HCT)
Prempro, low dose
Travatan Z* (travoprost)
fenofibrate cap DR
Niaspan* (niacin tab CR)
Verelan* (verapamil SR)
Norpramin* (desipra- mine)
Wellbutrin, SR* (bupro-
Wellbutrin XL* (bupro-
OneTouch: Ultra 2,
UltraMini, Verio IQ
Ortho Evra* (norelge-
Ortho Tri-Cyclen Lo
Testim* (testosterone td
Zomig, ZMT* (zolmitrip-
Timoptic XE* (timolol, XE) tan)
Toprol XL* (metoprolol
Zyprexa Zydis* (olanzapine ODT)
This is a partial list of medications that changes periodically. To ensure you have
the most current version of the standard formulary, visit magellanrx.com,
or call toll-free 1-800-424-5828.
Inclusion of a medication on this formulary is not a guarantee of coverage.
Please refer to your plan of benefits for coverage limitations and exclusions. Not all benefits
plans in all states are subject to quantity limits. For details regarding quantity limits for your
particular benefits plan, contact Customer Service at the telephone number listed on your
Additional Requirements for Coverage or
Limits on Certain Medications May Include:
Your prescription benefit program may have a prior authorization process for
certain medications. Prior authorization is a requirement that your physician obtain
approval from your health plan to prescribe a specific medication for you. Without
this prior approval, your health plan may not provide coverage for your medication.
If your physician prescribes a medication requiring a prior authorization, you will
need to go through a prior authorization process. We review requests for these
selected medications to help ensure appropriate and safe use of medications for
your medical condition(s). Your physician can call, fax, or submit prior authorization
requests electronically. For a list of select medications that require prior
authorization, please contact Customer Service at 1-800-424-5828
Quantity Limits and Step Therapy
Your Plan may have additional requirements for coverage or limits for select
prescription medications. These requirements and limits ensure that members
use these medications in the most effective way and also help the Plan control
medication costs. A team of practicing physicians and pharmacists developed these
requirements and limits to help your Plan provide quality coverage to members.
Please consult the formulary on our website for more information.
Quantity LimitsFor certain medications, your Plan may limit the amount of the medication that will be covered per prescription or for a defined period of time. For example, your Plan may provide up to 30 units per 30-day period for a formulary medication.
Step TherapyIn some cases, your Plan requires you to first try one medication to treat your medical condition before it will cover another medication for that condition. For example, if Drug A and Drug B both treat your medical condition, your Plan may require your physician to prescribe Drug A first. If Drug A does not work for you, then your Plan will cover Drug B.
You can find out if the
medication you take is
subject to these or other
or limits by looking in
the current formulary on magellanrx.com,
calling Customer Service at 1-800-424-5828.
Magellan Rx Management
Departments/Services for Members
National TRS, Dial 711
(For the hearing impaired)
(Provide 800# above)
Departments/Services for PhysiciansPrior Authorization
, Press option 4
Department HoursCustomer Service
24 hours a day, 7 days a week
In Case of EmergencyIn the event of an emergency or natural disaster, contact Customer Service for assistance. We will help you obtain an immediate refill at a local pharmacy if needed.
Allergies to Medications
Use the chart below to list all medications, both prescription and nonprescription,
to which you are allergic.
Type of reaction, such as rash or breathing difficulties.
Prescription MedicationsUse the chart below to list all brand name and generic prescription medications youcurrently take. Be sure to fill in all the information for each medication. The amount of medication in each pill appears on the prescription label in milligrams (mg). Thedosage is the amount of medication in each pill multiplied by the number of pills you take at one time.
(such as 3x/
(such as 3x/
About Magellan Rx Management
We're providing a smarter approach to pharmacy benefits – our
integrated solution combines comprehensive prescription benefits
management (PBM) services with specialty pharmacy expertise. We
help members by providing safe and effective prescription drugs at
the lowest total cost. Welcome to a unique vision of care. Welcome to
Magellan Rx Management.
How to Find Information About Your Plan
For the most up-to-date information about your prescription benefit
program, visit us online at magellanrx.com
or call Customer Service at 1-800-424-5828
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