Your Prescription Benefit Program
Welcome to
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, repre-
senting 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 the Rx Customer Service phone number located on
your identification card.
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 the Rx Customer Service phone number
located on your identification card. We are open 24 hours a day, 7 days a week.
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An Introduction to Your Prescription Benefit Program Your prescription benefit program is designed to help you and your eligible
dependents 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
medications.
• Helping you save money and providing convenient access to your
prescription medications.
• Helping you achieve the best possible health outcomes.
This booklet is an important resource — along with the Magellan Rx Management
website (magellanrx.com) and our Customer Service Department, who can be
reached at the Rx Customer Service phone number located on your identification
card. 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 Generic MedicationsThere 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.
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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.
Online ResourcesHealth Tools and Information are Just a Click AwayOur 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.
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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 magellanrx.com, 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.http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm101653.htm
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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 Plan’s Formulary?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 the
Rx Customer Service phone number located on your identification card.
For specific coverage and limitations information, as well as details about your
copay, please refer to your benefit plan documents.
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Magellan Rx Management Quick Reference FormularyMost Commonly Prescribed MedicationsAll 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 Customer Service toll-free at the Rx Customer Service
phone number located on your identification card.
Drugs are listed alphabetically by brand name.
KeyLowest Copay = (generics)Middle Copay = Preferred BrandHighest Copay = Non-Preferred Brand*
ACCU-CHEK
acyclovir
ADVAIR DISKUS
ADVAIR HFA
allopurinol
ALPHAGAN P
alprazolam
AMITIZA
amitriptyline hcl
amlodipine besylate
amlodipine besylate- benazepril
ANDRODERM*
ANDROGEL 1.62% GEL*
ANORO ELLIPTA
APRISO
ARNUITY ELLIPTA
atenolol
atorvastatin calcium
azithromycin
AZOPT
benzonatate
BREO ELLIPTA
BRILINTA
bupropion hcl sr
bupropion xl
buspirone hcl
BYDUREON
BYETTA
BYSTOLIC
BYVALSON
CANASA
carvedilol
celecoxib
cephalexin
CIALIS
ciprofloxacin hcl
citalopram hbr
CLIMARA PRO
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clindamycin phosphate
clobetasol propionate
clonazepam
clonidine hcl
clopidogrel
COLCRYS
COMBIGAN
COMBIVENT RESPIMAT
CREON
cyclobenzaprine hcl
dextroamphetamine- amphetamine er
diazepam
diclofenac sodium er
doxycycline hyclate
DUAVEE
duloxetine hcl
DYMISTA
ELIDEL*
EMBEDA*
escitalopram
esomeprazole magnesium
estradiol
fenofibrate
FLOVENT DISKUS
FLOVENT HFA
fluconazole
fluoxetine hcl
fluticasone propionate
furosemide
gabapentin
glimepiride
glipizide
HUMALOG
HUMALOG KWIKPEN
HUMALOG MIX
HUMULIN 70-30
HUMULIN N
HUMULIN R
hydrochlorothiazide
hydrocodone-acetamin- ophen
hydroxychloroquine sulfate
hydroxyzine hcl
ibuprofen
INCRUSE ELLIPTA
INVOKAMET
INVOKAMET XR
INVOKANA
JANUMET
JANUMET XR
JANUVIA
JARDIANCE
JENTADUETO
JENTADUETO XR
lamotrigine
LANTUS
LANTUS SOLOSTAR
LEVEMIR
levocetirizine dihydro- chloride
levothyroxine sodium
LINZESS*
lisinopril
lisinopril-hydrochlor- othiazide
lorazepam intensol
losartan potassium
losartan-hydrochlorothi- azide
lovastatin
LUMIGAN
meloxicam
metformin hcl
methocarbamol
methotrexate
methylphenidate hcl
methylprednisolone
metoprolol tartrate
metronidazole
minocycline hcl
MIRVASO
montelukast sodium
MOXEZA
mupirocin
MYRBETRIQ
naproxen
NATAZIA
NOVOLOG
NUVARING
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omeprazole
ondansetron hcl
ONETOUCH
oxycodone hcl
oxycodone-acetamino- phen
pantoprazole sodium
paroxetine er
pioglitazone hcl
PRADAXA
pravastatin sodium
prednisolone
prednisone
PREMARIN
PREMPHASE
PREMPRO
PROAIR HFA
PROAIR RESPICLICK
PROCTOFOAM-HC
progesterone
propranolol hcl
PULMICORT FLEXHALER
PYLERA*
quetiapine fumarate
QVAR
RANEXA
ranitidine hcl
RAPAFLO
RENVELA
RESTASIS*
rosuvastatin calcium
SEREVENT DISKUS
sertraline hcl
simvastatin
SOLIQUA *
SOOLANTRA
SPIRIVA
spironolactone
sprintec
STIOLTO RESPIMAT
sulfamethoxazole- trimethoprim
sumatriptan succinate
SYMBICORT
SYNJARDY
SYNJARDY XR
SYNTHROID
tamsulosin hcl
testosterone cypionate
tizanidine hcl
topiramate / er
TOUJEO SOLOSTAR
TRADJENTA
tramadol hcl
TRAVATAN Z
trazodone hcl
triamcinolone acetonide
triamterene-hydrochloro- thiazide
TRULICITY
ULORIC*
valacyclovir
valsartan
valsartan-hydrochlor- othiazide
venlafaxine hcl
VENTOLIN HFA
VESICARE
VIAGRA
VICTOZA
VIGAMOX
VYVANSE
warfarin sodium
WELCHOL
XARELTO
zolpidem tartrate
ZOVIRAX*
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Note: 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 the Rx Customer Service phone number located on your identification card. 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 identification card.
Additional Requirements for Coverage or Limits on Certain Medications May Include:Prior AuthorizationYour 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 the Rx Customer Service phone
number located on your identification card.
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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 additional requirements
or limits by looking in
the current formulary on
magellanrx.com, or by
calling Customer Service
at the Rx Customer Service
phone number located on
your identification card.
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Magellan Rx Management Contact Information Departments/Services for Members
Website magellanrx.com
Customer Service Please refer to the Rx Customer Service phone number located on your identification card
Customer Service National TRS, Dial 711 (For the hearing impaired) (Provide 800# above)
Departments/Services for PhysiciansPrior Authorization Phone: Please refer to the Rx Customer Service phone number located on your identification card, Press option 4
Electronically magellanrx.com
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.
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Medications ListAllergies to MedicationsUse the chart below to list all medications, both prescription and nonprescription,
to which you are allergic.
Medication Type of reaction, such as rash or breathing difficulties.
Prescription MedicationsUse the chart below to list all brand name and generic prescription medications you
currently 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). The
dosage is the amount of medication in each pill multiplied by the number of pills
you take at one time.
MedicationPrescribing doctor
Reason for taking the medication
Dosage How often? (such as 3x/day)
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MedicationPrescribing doctor
Reason for taking the medication
Dosage How often? (such as 3x/day)
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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 PlanFor the most up-to-date information about your prescription benefit program, visit us online at magellanrx.com or call Customer Service at the Rx Customer Service phone number located on your identification card.
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