Pharmacy
The US Family Health Plan has always provided a comprehensive prescription drug benefit to every member, regardless of age. With the price of medication these days, it's more important than ever.
Plan benefit: We cover prescription drugs when prescribed by an authorized US Family Health Plan practitioner.
Your cost: For urgent, short-term or one-time-fill prescriptions, the co-payment fee is $3 per prescription for generic medications, or $9 per prescription for brand-name medications. The fee covers up to a 30-day supply when filled at a participating US Family Health Plan pharmacy or up to a 90-day supply when filled by the Maxor Mail Order Pharmacy.
Save over 66% on long-term medications: When you use the Maxor Mail Order Pharmacy for long-term medications and prescription refills, you can get a 90-day supply by mail for the same co-payment as a 30-day supply at a participating US Family Health Plan pharmacy. There's no charge for postage or handling. Besides saving money, you'll save the time and trouble of driving to the pharmacy and waiting for your prescriptions to be filled.
How to get your prescriptions filled at participating pharmacies and through mail order: For urgent, short-term acute medications for 30 days or less: Present your US Family Health Plan member ID card at a participating US Family Health Plan pharmacy, which include Maxor Retail Pharmacies.
For maintenance medications used to treat ongoing, chronic illnesses, the Plan requires that they be filled routinely by mail order. Using the Maxor Mail Order Pharmacy saves you time and money, and couldn't be easier. The same $3 co-payment for generic drugs and $9 copayment for brand-name drugs also applies, but you get a 90-day supply of medication by mail for the same cost as a 30-day supply of medication from your local participating pharmacy. This saves you over 66% of the cost, as well as the time of going to the pharmacy and waiting for your prescriptions to be filled.
TRICARE recently started a new policy on 3rd tier medications. This policy requires a $22.00 co-pay for medications added to this 3rd tier list that do not meet medical necessity criteria. 3rd tier medications that do meet medical necessity will continue with the current co-pays. Medical necessity criteria include: allergic to, or failed (did not obtain the desired effect) , all similar medications on the preferred list. When clinically appropriate the USFHP will not require a new medical necessity statement for those members who have already been approved for 3rd tier drugs. When not clinically appropriate, a letter will be sent to each member explaining the new policy and reasons for any changes. For new 3rd tier prescriptions that do not meet medical necessity, the drug will be approved at the $22.00 co-pay rate. These medications will be available through Maxor mail order at $22.00 for a 3-month supply. These changes were enacted by the Department of Defense to encourage beneficiaries to use the most clinically appropriate, safe, and cost effective medications.
When obtaining an initial prescription for a maintenance medication, have your physician write two prescriptions: one for a 30-day initial supply and one for a 90-day maintenance supply. Fill the initial 30-day prescription at your local US Family Health Plan pharmacy. Then, mail your 90-day prescription to Maxor Mail Order Pharmacy.
Mail Order Instructions
1. Members must print and fill out both pages.
2. Members can go directly to www.maxor.com to order refills of mail order maintenance medication prescriptions directly through Maxor. For initial fills of maintenance medications, you will still need to fill out the paper form and mail it in with the doctor's prescription.
Preferred Drug List
Effective June 1, 2002, USFHP implemented a preferred drug list. It is a list of medications that offer clinical and/or economic advantages over competing drugs. All of the drugs on the preferred drug list meet the FDA's highest standards and are FDA approved as safe and effective.
Please note that it is Department of Defense policy to substitute generic medications for brand name medications when available. Brand name drugs not on the preferred drug list that have a generic equivalent may be dispensed when the prescribing physician demonstrates medical necessity. If a generic equivalent drug does not exist, the brand name drug will be dispensed at the brand name co-payment.
If your medication(s) is on the preferred drug list, there are no changes for you. If a medication prescribed for you is not on the preferred drug list, here is how it works:
• When you bring your prescription to the pharmacy, the pharmacist will note that the drug is not on the preferred drug list and will contact your physician to ask if a preferred drug may be substituted for the non-preferred drug. If your doctor feels it is clinically appropriate to substitute, the preferred drug will be dispensed.
• If your doctor does not wish to substitute and he or she can document the clinical need for the non-preferred drug, the non-preferred drug will be dispensed and your pharmacy profile will be noted for future walk-in and mail order requests. Have your pharmacist or doctor contact MaxorPlus for approval at 800-687-0707 .
» Click here for the latest Preferred Drug List.
» Click here to download a Non-Preferred Drug Request form. This form must be filled out and faxed by the prescribing physician only. Members may not fill out or fax this form.
Pharmacy Locations
Select one of the locations below to see the corresponding pharmacy listing.
Note: Links open in new window.
• New York
To contact the Maxor Mail Order Pharmacy , call 1-866-408-2459 or write to:
USFHP/Maxor Mail Order
P.O. Box 32050
Amarillo , TX 79120
