Your Prescription Drug Benefit may be subject to limitations and exclusions such as those listed below. For a complete list, refer to your handbook and commercial formulary document.
- A prescription unit or refill is covered for up to a 30-day supply (or a 90-day supply of a generic drug at any participating retail pharmacy). Refills on prescriptions are not covered until at least 75% of the previous prescription is used based on the dosage schedule prescribed by the physician.
- Certain prescription drugs require prior authorization for coverage. For instructions on how to obtain prior authorization, please contact Member Services at (850) 383-3311 Monday through Friday, 8:00 a.m. to 5:00 p.m. For information on prior authorizations, formularies, quantity limits and criteria please visit MyPrime Commercial.
- If a generic drug is available and a more expensive brand name prescription drug is dispensed at the request of the member or the prescriber, the member must pay the copayment amount for the brand name drug plus pay the pharmacist 100% of the additional cost for the more expensive brand name prescription drug.
- CHP may limit quantities for medications prescribed to be taken on a p.r.n. (as needed) basis.
Please note: Medicare members have a different drug list, called the Medicare Advantage Formulary. If you are a Medicare member, please select your plan for information on your prescription drug benefits.