Important Pharmacy Information

How do I get a pharmacy reimbursement if I paid out of pocket?

Request an itemized receipt from your pharmacy. The pharmacy must include the patient’s name, doctor’s name, drug name, quantity, purchase amounts and date (it is not the cash register receipt). Make two copies of the itemized receipt. Save one copy for yourself and send the second copy to:

US Family Health Plan
Attn: Claims
PO Box 169001
Irving, TX 75016

Which drugs are on the formulary?

This website contains a list of brand name drugs and their generic equivalents.

 

Do some prescriptions require prior approval?

Yes. The Department of Defense Pharmacy and Therapeutics Committee (DoD P & T) establishes a list of medications that require prior approval before the plan will cover the cost of the medication. When you present a prescription to a network pharmacy that requires prior approval, they will begin the prior authorization process for you. Maxor Plus will contact your physician for the required information.


How do I transfer a local prescription to Mail Order?

Call Maxor Mail Order at 1-866-408-2459 and choose the option “Request a prescription transfer.” Have the following information ready to give to the pharmacy: pharmacy name, pharmacy telephone number, patient name, prescription number and drug name. Make sure the mail-order pharmacy has your correct address and phone number on file. Allow 14 days for medication delivery.

 

How do I transfer a prescription from CVS to a local Maxor Pharmacy or other network pharmacy?

Call the local pharmacy directly. Have the following information ready to give to the pharmacy: pharmacy name, pharmacy telephone number, patient name, prescription number and drug name. Please allow one business day for the pharmacy to transfer the information.

 

Which drugs are covered?

Please visit TRICARE to research your prescriptions.

 

What is a generic medication?

Many well-known brand name drugs have generic equivalents that are chemically identical to the brand name drugs. Generics are just as potent, pure, safe and reliable as their brand name counterparts. The Food and Drug Administration (FDA) requires that all generic drugs undergo rigorous testing to prove they are the same as the brand name drug.

It’s Department of Defense policy to substitute generic medications for brand name medications when a generic equivalent is available. Brand name drugs that have a generic equivalent may be dispensed only if the prescribing physician is able to justify medical necessity for use of the brand name drug in place of the generic equivalent.

If a generic equivalent drug does not exist, the brand name drug will be dispensed at the brand name copayment. If you insist on having a prescription filled with a brand name drug that is not considered medically necessary, and when a generic equivalent is available, you will be responsible for paying the entire cost of the prescription.

 

How do I get my medications in case of a disaster?

Go to your nearest CVS pharmacy. If there is not a CVS pharmacy, call Maxor Plus at 1-800-687-0707. This number is also located on the back of you ID card under Pharmacy Claims Problems.

 

How do I order a refill prescription?

If the prescription was originally filled at Maxor Pharmacy, call the telephone refill system. If you want to have your prescription filled at a local Maxor Pharmacy call 1-800-687-8429. If you prefer to have your prescription mailed to you, call the Mail Order telephone refill system at 1-866-408-2459. Or you can order on the Internet at www.maxor.com.

 

Can I fax a new prescription?

Only your doctor can fax new prescriptions.

 

What do I do if I am out of refills?

Both the local pharmacies and the mail-order pharmacy will contact the doctor to obtain more refills for you. You can order the refills as you normally do (telephone, Internet or mail), and we will contact the doctor. Please allow up to three extra business days. If your doctor has changed, contact the pharmacy directly with the new information.

 

How can I minimize my out-of-pocket expenses?

Ask your doctor to prescribe generically whenever possible. Generic medications have the lowest copay on your prescription drug benefit. Have your maintenance medications filled through the mail-order service; you will save 66 percent on your copay. You will receive a 90-day supply, for the same copay price as a 30-day supply.

 

Provider Summer Issue

News for US Family Health Plan Providers

Summer 2016

View all news

Follow us on social for the most up to date news and event information.