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Drug list (formulary)
A drug list is a list of drugs, or prescriptions, that a plan covers. AmeriHealth Caritas VIP Care Plus (Medicare-Medicaid plan) will generally cover the drugs listed in our drug list as long as the drugs are medically necessary. The prescription also needs to be filled at a network pharmacy, and other plan rules need to be followed. For more information on how to fill your prescriptions, see the AmeriHealth Caritas VIP Care Plus Member Handbook (PDF).
The drug list includes the drugs covered under Medicare Part D and some prescription and over-the-counter (OTC) drugs covered under your Michigan Medicaid benefits.
AmeriHealth Caritas VIP Care Plus covers both brand name drugs and generic drugs. Generic drugs have the same active ingredients as brand name drugs. 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.
Want regular information about your pharmacy benefits? Look out for your monthly Explanation of Benefits (EOB) in the mail.
AmeriHealth Caritas VIP Care Plus 2017 drug list
Drug list updates
As of August 1, 2017, AmeriHealth Caritas VIP Care Plus is removing Harvoni and Sovaldi from our List of Covered Drugs, which is also called a formulary (form-u-lar-e). Zepatier and Epclusa are being added to the formulary. These medicines will be the preferred medicines to treat Hepatitis C beginning August 1, 2017.
Zepatier and Epclusa are medicines that work like Harvoni and Sovaldi and are more cost effective.
If you currently are approved by the Plan to take Harvoni and Sovaldi to treat Hepatitis C, you will be able to keep taking the medicines for the rest of the plan year. There will be no change to your copay, deductible, or coverage.
You and/or your primary care provider (PCP) or other provider can ask for an exception to the AmeriHealth Caritas VIP Care Plus drug list. Read our Prescription Drug Frequently Asked Questions (FAQ) for information on how to request an exception.
|Drug||Type of change||Effective date of change||Tier||Necessary actions, restrictions,
or limits on use
|Harvoni||Removal||8/1/2017||2||Prior authorization is required.|
|Sovaldi||Removal||8/1/2017||2||Prior authorization is required.|
|Epclusa||Addition||3/1/2017||2||Prior authorization is required.|
|Zepatier||Addition||3/1/2017||2||Prior authorization is required.|
To ask for an updated drug list call Member Services at 1-888-667-0318 (TTY/TDD 711), 8 a.m. to 8 p.m., 7 days a week or download the following form.