Physician Leadership, Quality Care, Community Focus

Pharmacy


CHN Pharmacy Coordination 

The Cleveland Health Network Pharmacy Program applies a value-based approach to providing a comprehensive prescription drug benefit to plan participants.  A wide range of utilization management strategies are used to ensure the timely delivery of effective, safe drug therapy that is affordable for both the individual member and program sponsors.  These strategies include: 
  • Utilize a four-tier prescription drug formulary, with medication selection based on efficacy, safety, unique value, and cost 
  • Support and encourage the use of FDA-approved generic drugs that are both chemically and therapeutically equivalent to manufacturer’s brand name products 
  • Promote cost savings for members when obtaining prescriptions through preferred pharmacies 
  • Maintain a nationwide network of pharmacies through the CHN and CVS Caremark partnership 
  • Utilize a prior authorization program to ensure that high cost medications are used appropriately 
  • Apply medication quantity limits to promote safe medication use and to prevent waste 
  • Apply step therapy programs to certain medications to help ensure the first line use of equally effective, less expensive alternative medications for a given medical condition

If you have a question that we can be of assistance with, the Pharmacy Coordination Department can be reached at 216-986-1050, option 4.

 

Formulary

The Cleveland Clinic Employee Health Plan (EHP) Total Care Prescription Drug Benefit is administered through CVS Caremark. The medications included in the Cleveland Clinic EHP Total Care Drug Formulary Book are chosen by a group of healthcare professionals known as the Pharmacy and Therapeutics (P&T) Committee. This Committee reviews and selects FDA-approved prescription drugs for inclusion in the Formulary based on the drug's safety, effectiveness, unique value, and cost to the plan. The Formulary will assist in maintaining the quality of patient care while helping to keep the cost of prescription medications affordable. All medications that have been reviewed but not added to the Formulary or that have not yet been reviewed by the P&T Committee are considered Non-Formulary.

The P&T Committee reviews and updates our Formulary throughout the year. This means that drugs can be added to or removed from the Formulary during the year. Cleveland Clinic Employee Health Plan Total Care may add drugs to the Formulary four times a year, or once a quarter. Drugs may be removed from the Formulary twice a year, once at the start of the benefit year in January and again at mid-year in July.
 


Mandatory Maintenance and Mandatory Three Month Supply Programs For Cleveland Clinic EHP Total Care Members

Maintenance drugs are prescriptions commonly used to treat conditions that are considered chronic or long-term. These conditions commonly require regular, daily use of medication(s). Examples of maintenance drugs are those used to treat asthma, diabetes, heart disease, and high blood pressure.  The Cleveland Clinic Employee Health Plan Total Care Maintenance Drug List includes those medications considered maintenance medications. Members covered under the EHP Total Care Prescription Drug Benefit can obtain the first fill of any of these medications at any pharmacy. Refills for maintenance medications must be obtained at a Cleveland Clinic Pharmacy, through the Cleveland Clinic Home Delivery Pharmacy, or though the CVS Caremark Mail Service in order to be covered.

In addition, those maintenance medications that are highlighted in red must be refilled for three month supplies at a Cleveland Clinic Pharmacy, through the Cleveland Clinic Home Delivery Pharmacy, or through the CVS Caremark Mail Service in order to be covered.


 

Prior Authorization

Prior Authorization is necessary for coverage of certain medications. A Prior Authorization/Formulary Exception Form must be completed and submitted by your physician before a request will be reviewed.  Forms can be faxed to 216-643-7378. All requests must meet the clinical criteria established by the P&T Committee before approval is granted.

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6000 West Creek Road, Ste 20
Independence, Ohio 44131
Call: 216.986.1100