Remington Pharmaceutical Products

[Pablo Tatts]

TheUSFHP Pharmacy Program provides outpatient coverage to beneficiaries for medications that are approved for marketing by the U.S. Food and Drug Administration (FDA) and that generally require prescriptions. Other covered medications/products include:

USFHP utilizes the TRICARE pharmacy formulary. The TRICARE formulary and pharmaceutical management policies are developed by the Department of Defense Pharmacy and Therapeutics Committee. The TRICARE formulary is a tiered, open formulary and includes generic drugs (Tier 1), preferred brand drugs (Tier 2), and non-preferred brand drugs (Tier 3). The Formulary is updated on a regular basis including Tier changes and utilization management requirements. Review the changes that will be made to the formulary.

Generic drugs are chemically identical to their branded counterparts. They are made with the same active ingredients, and produce the same effects as their brand name equivalents. The Food and Drug Administration (FDA) requires generic drugs to have the same quality, strength, purity, and stability as brand name drugs. Also, the FDA requires that all drugs, including generic drugs be safe and effective.

Although generic drugs are chemically identical to their branded counterparts, and are held to the same FDA standards for safety and performance as brand name drugs, they sell for 30-75 percent less. Additional information on generic drugs is available on the FDA website.

To initiate a prior authorization, providers must complete and fax the prior authorization form for the specific medication to the Johns Hopkins Health Plans Pharmacy department at 410-424-4037. In case the medication is not listed, providers may use the non-drug specific prior authorization form.

Please note: If another Health Plan or TRICARE has previously approved a medication, USFHP will not have access to that information. If you have copy of the previous approval letter, please fax it along with the Prior Authorization Form to USFHP Pharmacy Review department.

If a USFHP member's medical condition warrants use of quantities greater than listed quantity limit for their medication, Providers may submit a Prior Authorization request for use of the higher quantity. Providers must provide medical justification for use of the higher quantity. Download a copy of the Pharmacy Prior-Authorization form, complete and fax the Prior Authorization form to the Johns Hopkins Health Plans Pharmacy department at 410-424-4037.

Step therapy involves prescribing a safe, clinically effective, and cost-effective medication as the first step in treating a medical condition. The preferred medication is often a generic medication that offers the best overall value in terms of safety, effectiveness and cost. Non-preferred drugs are only prescribed if the preferred medication is ineffective or poorly tolerated.

Note: A member who has filled a prescription for a step-therapy drug within 180 days prior to the implementation of step therapy, will not be affected by step-therapy requirements and will not be required to switch medications. Please note that the coverage terms of this prescription benefit are subject to change

If a provider determines that a step therapy requirement is not appropriate for a member, the Pharmacy Prior Authorization Form may be submitted for review. To initiate a prior-authorization, providers must complete and fax the prior authorization form for the specific medication to the Johns Hopkins Health Plans Pharmacy department at 410-424-4037. In case the medication is not listed, providers may use the non-drug specific prior authorization form.

The Johns Hopkins USFHP Plan allows retail prescription processing at any Walgreens pharmacy in the United States (including those Rite Aid pharmacies that converted to Walgreens pharmacies). Prescriptions may be filled for up to a 90 day supply at any network pharmacy. For members who prefer to utilize a mail order program for maintenance medications, the Walgreens Pharmacy at Remington provides this service for Maryland Residents only. Members who live outside of Maryland may obtain home delivery from AllianceRx Walgreens Prime Pharmacy in Arizona.

To ensure safety and effectiveness of compound drug claims and to manage cost, some compound medications when rejected at the pharmacy may require prior authorization. The provider may complete the Compound Prior Authorization Form and fax to the Johns Hopkins Health Plans Pharmacy department at 410-424-4607 for review. The provider must provide clinical documentation to support the request and demonstrate that an FDA approved commercially-available product is not clinically appropriate for the member.

Specialty Medications are usually high-cost prescription medications used to treat complex chronic conditions. These drugs typically require special storage and handling, and may not be readily available at a local pharmacy. Specialty medications may also have side effects that require pharmacist and/or provider monitoring.

Providers may supply any vaccine for any age group under the medical benefit as long as a scheduled vaccine is in line with the Advisory Committee on Immunization Practices (ACIP) recommendations. Certain common vaccines such as Flu, Pneumonia and Shingles vaccines may be also be administered by Pharmacists at select Walgreens pharmacies.

"Community/outpatient pharmacy" means an established place in which prescriptions, drugs, medicines, chemicals, and poisons are prepared, compounded, dispensed, vended, distributed, or sold to or for the use of nonhospitalized patients and from which related pharmaceutical care services are provided. Practitioners, as defined in Minnesota Statutes, section 151.01, subdivision 23, dispensing prescription drugs to their own patients in accordance with parts 6800.9950 to 6800.9954 are not included within this definition.

"Community satellite" means a site affiliated with a licensed community pharmacy, which is dependent on the licensed community pharmacy for administrative control, staffing, and drug procurement. A community satellite must be under the direction of a licensed pharmacist and comply with the requirements of part 6800.0800, subpart 3.

"Expiration date" means the date placed on the container or label of a drug product designating the time during which the product is expected to remain within the approved shelf life specifications if stored under defined conditions, and after which it may not be used.

"Hospital pharmacy" means an established place located in a licensed hospital in which prescriptions, drugs, medicines, chemicals, and poisons are prepared, compounded, dispensed, vended, distributed, or sold to hospitalized patients and from which related pharmaceutical care services are delivered.

"Hospital satellite" means a site in a licensed hospital, which is not physically connected with the centrally licensed pharmacy, but is within the same facility or building and is dependent on the centrally licensed pharmacy for administrative control, staffing, and drug procurement. A hospital satellite must be under the direction of a licensed pharmacist, comply with the requirements of part 6800.0800, subpart 3, and provide pharmacy services to hospital patients only.

"Long-term care pharmacy" means an established place, whether or not in conjunction with a hospital pharmacy or a community/outpatient pharmacy, in which prescriptions, drugs, medicines, chemicals, or poisons are prepared, compounded, dispensed, vended, distributed, or sold on a regular and recurring basis to or for the use of residents of a licensed nursing home, boarding care home, assisted living facility, or supervised living facility and from which related pharmaceutical care services are delivered.

For the purposes of this chapter, the term "assisted living facility" means a registered housing with services establishment, as defined in Minnesota Statutes, section 144D.01, subdivision 4, that provides central storage of medications for residents.

"Nuclear pharmacy" is an area, place, or premises described in a license issued by the board with reference to plans approved by the board where radioactive drugs are stored, prepared, manufactured, derived, manipulated, compounded, or dispensed and from which related clinical services are provided.

"Home health care pharmacy" means an established place, whether or not in conjunction with a hospital pharmacy, long-term care pharmacy, or a community/outpatient pharmacy, in which parenteral or enteral drugs or medicines are prepared, compounded, and dispensed for the use of nonhospitalized patients and from which related pharmaceutical care services are provided.

"Pharmaceutical care" means the responsible provision of drug therapy and other pharmaceutical patient care services by a pharmacist intended to achieve definite outcomes related to the cure or prevention of a disease, the elimination or reduction of a patient's symptoms, or the arresting or slowing of a disease process.

"Prescription drug order" means a lawful written, oral, or electronic order of a practitioner for a drug for a specific patient. A prescription drug order must contain the information specified in this chapter and in Minnesota Statutes, section 151.01, subdivision 16.

"Prescription" means a prescription drug order that is written or printed on paper, an oral order reduced to writing by a pharmacist, or an electronic order. To be valid a prescription must be issued for an individual patient by a practitioner within the scope and usual course of the practitioner's practice, and must contain the date of issue, name and address of the patient, name and quantity of the drug prescribed, directions for use, the name and address of the practitioner, and a telephone number at which the practitioner can be reached. A prescription written or printed on paper that is given to the patient or an agent of the patient, or transmitted facsimile-to-facsimile must contain the practitioner's manual signature. An electronic prescription must contain the practitioner's electronic signature.

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