Prescription Drug List 2004

Prescription Drug list frequently asked questions;

How is this list developed?

How is the list maintained as new drugs are approved?

What if a drug is not listed but an Oxford Provider requests it to be added?

Are all forms (tablet, capsule etc…) of a listed drug covered?

Are only outpatient prescription drugs covered?

Will a Preferred drug be dispensed instead of a non-Preferred drug?

Please note that certain prescription drugs require precertification.

How is this list developed?
The Drug Formulary is developed by the Oxford Health Plans, Inc. Pharmacy and Therapeutics Committee (P&T Committee). This committee, composed of physicians from various medical specialties and pharmacists, reviews the medications in all therapeutic categories.

How is the list maintained as new drugs are approved?
Formulary development and maintenance is a dynamic process. Our P&T Committee will regularly review new and existing medications so that the formulary remain responsive to the needs of our Members and providers. The formulary will be republished annually and updated periodically in the Provider Program & Policy Update (PPU).

What if a drug is not listed on the plan, but an Oxford provider requests it to be added? If a participating physician requests that a new or existing medication be added to the Drug Formulary, a letter indicating the significant advantages of the drug product over current list medications should be sent to the following address:

Oxford Health Plans, Inc.
P&T Committee Chairperson
48 Monroe Turnpike
Trumbull, CT 06611
Fax: (203) 459-3354

Are all forms (tablet, capsule, etc.)of drugs covered?
Unless exceptions are noted, all forms (tablet, capsule, liquid, topical) and strengths of a drug product are included in the list and may be covered by the plan, if the Member has the appropriate prescription drug coverage.

Are only outpatient prescription drugs covered?
This prescription drug list only applies to outpatient prescription drugs dispensed by participating pharmacies. This list does not apply to inpatient medications or to medications obtained from and/or administered by a physician.

Will a Preferred drug be dispensed instead of a Non-preferred drug?
Physicians are encouraged to utilize the preferred drug list when prescribing medications for Members. If a pharmacist receives a prescription for a non-preferred drug, depending on the Member's plan design, the pharmacist may attempt to contact the physician to request a change to a preferred product. If the physician is unwilling to change, or is unavailable, the pharmacist will dispense the prescription as written and the applicable copayment (cost share) will apply.