Pharmacy

Formulary Advantage Program

Effective July 15, 2011, several new drug classes have been added to the SMHP Formulary Advantage program:

• Antidepressants
• Antipsychotics
• Blood Pressure
• Migraines
• Nasal Allergy
• Osteoporosis
• Sleep Aids
• Testosterone Replacement.

Medications requiring Step Therapy will no longer be routinely covered and the member will be required to pay the full cost of the drug at the pharmacy. Members affected by this change have been informed of this new process and will be encouraged to either obtain a new prescription for a preferred alternative or have a Prior Authorization request submitted to Catalyst Rx for continued coverage of their non-preferred medication.

For an example of the SMHP member letter (using osteoporosis medications as the example), click here.

For an example of the SMHP prescriber letter, click here.

Change in Growth Hormone Medications

Effective September 1, 2011, the Saint Mary Health Plans' prescription drug plan, administered by Catalyst Rx, will implement a change in coverage for growth hormone medications (somatropin). At this time, non-preferred brand-name growth hormone medications other than Norditropin will no longer be covered and the member will be required to pay the full cost of the drug at the pharmacy.

For a copy of the member communication regarding this transition, click here.

For a copy of the prescriber communication regarding this transition, click here.