Healthy Focus Medical Plans

Prior Authorization

prior mandate is a feature of your prescription benefits plan that helps ensure the appropriate manipulation of selected prescription drugs. Certain prescription drug drugs require your doctor to get approval before they ‘re covered. This work helps make sure you receive the correct medicine in the correct acid, which is identical important if you ‘re taking a peculiarity drug. These medicines are merely approved for particular conditions and normally require keeping in close contact with your doctor. Prior mandate takes the extra measure to watch forte drugs .
Read the FAQs to learn more .

Step Therapy

footstep Therapy is an approach intended to control the costs and risks posed by certain prescription drugs. It begins with a drug therapy for a medical stipulate with the most cost-efficient and dependable drug therapy and progresses to other more costly or hazardous drug therapies lone if necessary. here ’ s an example of step therapy :

• You try an over-the-counter medication for an allergy, but it doesn’t control your symptoms.
• Your doctor prescribes a prescription drug that still doesn’t give you relief.
• A third medication that’s more expensive works well, but requires step therapy.

In this case, your prescription drug is covered if you ‘ve tried the first option drugs.

Read the FAQs to learn more .

Smart90

With this course of study, you have two ways to get a 90-day provision of your long-run care medication — drugs you take regularly for ongoing conditions. You can conveniently fill these prescriptions through the Express Scripts mail service or any Walgreens network drugstore. Your copay/coinsurance for your 90-day issue of medicine will be the same whether you fill your prescriptions through Express Scripts home delivery or at a Walgreens network pharmacy .
note : If you continue to fill 30-day supplies of your long-run medication after the foremost two fills, you will pay a penalty ( 100 % of the prescription drug cost ). Penalties paid for not filing prescriptions through Express Scripts ( ESI ) mail order or Walgreens will not count towards the deductible or out-of-pocket maximal. additionally, participants will still pay penalties after they meet their out-of-pocket utmost .
Read the FAQs to learn more.

Patient Assurance Program

If you are enrolled in a goodly Focus medical plan you will have access to the Patient Assurance Program ( PAP ) administered by Express Scripts. With this platform, when you fill a prescription for a blue-ribbon diabetes intersection as part of the PAP, you will pay no more than $ 75 for a 90-day prescription drug for certain insulin products at retail or mail order. In other words, your out‑of‑pocket sum is capped and importantly reduced at the point‑of‑sale for both home plate delivery and in-network retail pharmacies. Any copay sum paid will apply to your annual out-of-pocket maximum lone. Select diabetes medications are included within the follow categories :

• Preferred insulins
• Preferred non-insulin diabetes medications (DPP-4 inhibitors, GLP-1 agonists and SGLT2 inhibitors)

Note: all prescription drug fills for care medications are subject to the terms of the Smart90 platform .
denote to the Drug List to view the prescriptions included in the course of study.

Propeller

If you are enrolled in a healthy Focus medical plan and have asthma or COPD, Express Scripts ( ESI ) has partnered with Propeller to offer a detached plan to help you manage your breathing .
Propeller is a digital health tool that ’ s clinically proven to reduce the use of rescue inhalers and to help you have more days without symptoms .

• Download the Propeller app to your phone
• Get your inhaler sensors in the mail and sync with the app
• The app learns about your breathing, builds your personalized profile and provides:
  • Reminders to help you stay on track
  • A record of your medication use
  • Help determining your triggers
  • Tips to help you breathe easier
  • Progress reports you can share with your healthcare provider

Log in to your Express Scripts report at express-scripts.com/healthsolutions to see if you are eligible for the Propeller course of study .