Last issue, we defined some frequently-used terms to describe pharmacy benefits. This issue, we look at some other common terms related to your formulary:
PRIOR AUTHORIZATION (PA): As part of our commitment to your health, we work with your providers to make sure that the medication being prescribed to you is appropriate based on your conditions and medication history. Prior authorization refers to the process for certain medications in which the pharmacy benefit manager provides an authorization before they will pay for the medication. This authorization may require you or your provider to submit a form to the pharmacy benefit manager to review. PAs are required for select medications to ensure the medication you are being prescribed is the most appropriate option based on your health and medication history, and treat your condition without unintended side effects.
STEP THERAPY (ST): Similar to prior authorization, we want to make sure that you are being prescribed the right medication for your condition and medication history. To achieve this, in some cases we use step therapy. This means that an alternative medication may be prescribed to treat your condition before your plan will cover the medicine your doctor first prescribed for you. This is to ensure that the most common therapies, are tried before selecting certain medications.
QUANTITY LIMITS (QL): Certain prescriptions can be expensive or put you at risk for abusing them. To protect your wallet and your health, quantity limits are sometimes put in place. These are requirements that limit the amount of a medication that can be given to you in a certain time period. They are often used for very expensive medications or medications that are known to have a risk of abuse or misuse.
HOME DELIVERY: Convenience is often a key part of adherence to a prescription, which is why we offer home delivery. Home delivery is a service in which medications you use long term can be mailed or delivered to your home. You can see if your pharmacy has a home delivery option or you can utilize AllianceRx in your home.
MEDICATION THERAPY MANAGEMENT (MTM): As part of your Blue Cross Medicare Part D offering, you can have a consultation with a specially trained pharmacist to ensure your medications are the best choice for you, working like they should, not causing side effects or harmful interactions, and are easy for you to take. These consultations are offered at no charge and are part of your Medication Therapy Management (MTM) program. During an MTM consultation, your pharmacist will work with you to review all of your medications, identify, resolve, and prevent medication related problems and then provide a summary for you and your health care team of any recommendations. MTM is a great service for your peace of mind and can help address medication problems before they become serious. If you are interested in an MTM consultation, call 866-873-5941 (TTY 711), Monday through Friday, 9 a.m. to 5 p.m. Central.