Presbyterian Senior Care (HMO) and Presbyterian MediCare PPO | Summer 2019 | Your Story

6 Presbyterian Health Plan online provider directory Presbyterian Health Plan has a web- based provider directory on www.phs .org . Choose “Find a Doctor” in the red box on the right of the screen. Both members and nonmembers can search for providers using this online tool. In the directory, you can search the following information: ● ● Name ● ● Gender (male/female) ● ● Specialty ● ● Hospitals where they practice ● ● Board certification ● ● If they are accepting new patients ● ● Languages they speak in the office ● ● Office locations and phone numbers You can search on one or more of the items listed above. To get all of the information you want, fill in as many blanks as you want on the search page. The search page has instructions for both smartphone users and computer users. You can also get provider information on paper or by phone by calling the Presbyterian Customer Service Center at the number on the back of your member ID card. Your prescription drug coverage Your prescription drug benefits provide cost-effective coverage and value with your safety in mind. If prescription drugs are included in your benefits, they generally cover: ● ● Generic and brand-name drugs listed on our Formulary (list of covered drugs) ● ● Certain specialty Pharmaceuticals Check your 2019 Evidence of Coverage, the 2019 Summary of Benefits, or call the Presbyterian Customer Service Center (PCSC) to find out more. Why dowe have a Formulary? Having a Formulary (a Preferred Drug List of covered drugs) helps us keep your out-of-pocket costs down. The list contains thousands of drugs and is reviewed and updated by a committee of healthcare providers and pharmacists. Ask your provider to use the Health Plan Formulary when choosing drugs to treat your health condition or disease. The Formulary includes notes on a drug’s requirements or restrictions, such as prior authorization, step therapy, quantity limits, and limits on dosage forms and/or strengths. Why do some drugs have restrictions? Some covered drugs may have additional requirements or restrictions to ensure you are getting the safest and best drug for your health condition or disease, while keeping your cost at a minimum. When a drug needs a prior authorization, we make every effort to review each request as quickly as possible. Reviews are generally completed within 24 to 48 hours when all of the required medical information is included with the request. If you need a drug that is not on the Formulary, you or your provider can request an exception. We will look at the request and work with your provider to determine if the drug is medically necessary. Our clinical pharmacists are available to work with you and your provider to find a Formulary drug that works for your health condition and to find less expensive generic drugs instead of using a brand name. For more information about the types of exception requests, check your 2019 Formulary or call the PCSC to find out more. To ask your plan for an exception, you can call the PCSC at the phone number on your member ID card. You may also submit an exception request on-line at www.phs.org/mypres . Log in to myPRES and select “Access MyPharmacy” to find the “My Medicine Cabinet” homepage. Select “Member Tools” and then “Drug List” from the tool bar, then click the hyperlink to submit an exception request. Please note, the first time you follow these steps you will be asked to register with OprumRx for a Healthsafe ID. Presbyterian partners with Optum Rx to provide pharmacy benefit information. Future visits will go faster. You can find the Formulary at www .phs.org/Medicare . Select “Prescription Drugs,” then “Formulary (Drug list).”