Prescription Drugs

The formulary is a list of the drugs that we cover.  Generally, we will cover the drugs listed on our formulary as long as the drug is medically necessary and the prescription is filled at a network pharmacy.  See below for information on restrictions and limitations.  We may add or remove drugs from our formulary during the year.  We will provide updates when the formulary changes.

For more information, click here. The formulary will tell you about:

 

Every 3 months, AlohaCare's Pharmacy and Therapeutics (P&T) Committee may change medications to the QUEST Integration Formulary. This committee includes doctors and pharmacists, and they decide which medications are on the list.

 

Below are the changes from each meeting. Please talk with your doctor about any medication changes that may affect you.

 

 

The Food and Drug Administration (FDA) ensures that a drug is safe and effective before it is available on the market. The FDA can recall a drug so it is not available.

 

A recall can happen when a drug is found to be either defective or could be harmful for use.

 

There are 3 types of recalls required by the FDA. The type of recall is based on the level of danger involved:

Drug companies may also decide to remove a drug or product for other reasons. This is called withdrawal. Example: A drug is removed from the market due to tampering.

 

The AlohaCare Pharmacy Department will tell members, doctors, and pharmacies when there is a Class I or Class II drug recall. We also inform our members in writing when drugs are withdrawn from the market for safety reasons. 

 

AlohaCare reviews drug recalls and withdrawals every 3 months. The review takes place in a meeting with a group of pharmacists, doctors, and nurse practitioners. This meeting is called the Pharmacy and Therapeutics (P&T) Committee.

 

Please talk to your doctor about any details on drug recalls and withdrawals that may affect you.

 

 

 

 

There is little difference between a brand name drug and the generic version.  Generic drugs have the same ingredients as brand name drugs.  They are usually a different color and shape.  Generic drugs are not as expensive as brand name drugs.  Your pharmacy will fill your prescription with a generic drug if it is available.  Generic medications are as safe and effective as their brand name drugs. 

AlohaCare has a committee of physicians and pharmacists that decide about our medication procedures.  They review the available drugs and select the ones that they believe are the best for our members. 

Most of the time, you will get a 30 day supply unless your doctor orders a supply for a shorter period of time, based on your need for the drug (for example, antibiotics). Some covered drugs may have additional requirements or limits on coverage. These limitations are marked next to each drug on the formulary with "LA," "PA," "QL" or "ST." Situations in which a drug limit may apply include: 

Generic substitution or therapeutic interchange may also apply. You may be asked to take a drug that is chemically identical (not brand name) or chemically different from the drug originally prescribed. This substitution or change will have the same therapeutic purpose and will be used for the same FDA approved conditions. The pharmacist or prescriber may ask you to take this drug and will explain the reasons why he or she believes this is a better drug choice for you. You do not have to agree. If you do not agree, you or your physician may request a prior authorization (PA).

You pay nothing for prescribed drugs that are on AlohaCare's list of covered drugs. These drugs are covered in full by your AlohaCare QUEST Integration plan.