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Formulary Information
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CUP maintains a Formulary according to the requirements mandated by Medical Assistance
Administration and the Health Care Authority. The Formulary includes coverage for
all therapeutic classes.
Practitioners are required to review the CUP Formulary and provide a prescription
for a generic drug if one is available and if it is the most appropriate therapy
for the member. Practitioners shall provide the member with the most cost-effective
therapy when appropriate.
On an annual basis, the CUP Pharmacy & Therapeutics Committee will review the
Formulary and make any changes or updates to the formulary prior to submitting the
Formulary for approval to the state agencies.
CUP will provide practitioners with a copy of an approved Formulary in an electronically
or written format and will educate practitioners of any changes when they occur.
The approved Formulary will also be posted on CUP’s website at
www.cuphealth.com.
Changes to the Formulary occur when either the Medical Assistance Administration
has approved a drug for coverage under the Medicaid Fee-For-Service program or when
CUP’s Pharmacy & Therapeutics Committee has reviewed the Amerigroup Formulary
updates on a monthly basis and agrees to include new drugs in the formulary.
Any Practitioner may request the addition of a drug to the Formulary by providing
CUP or MedImpact with information and documentation of the requested drug and by
filling out a “Request for
Addition or Change to the Formulary” Form. This request will be submitted
to the Pharmacy & Therapeutics Committee for review and consideration of the
request. The Practitioner will be notified of the decision of the Committee.
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