STANDARD NETWORK MEMBERS SAVE TIME AND MONEY ON PRESCRIPTIONS What is FastStart? FastStartSM by Caremark helps you access valuable discounts through prescriptions by mail. Order many maintenance medications—those you refill monthly for conditions like diabetes, high blood pressure, or asthma—and save up to 33% off a three-month supply. Please refer to your Plan Benefit Summary in your annual enrollment materials for details. Save Money through Mail Order with FastStart Getting started is easy. Just call FastStart toll free at 1-866-281-0629 with the Advantages to FastStart
• Tufts Health Plan ID card (you’ll need information from the card)
• Medication name • Physician name and phone number
• Credit card information and expiration date
FastStart calls your doctor to get the prescription set up for mail order. After you
get a prescription set up, you can refill online or by phone—any day, any time. If
you have any questions about FastStart by Caremark, please visit our Web site atwww.tuftshealthplan.com. Switching to Generics Can Save You Money
Did you know that switching to a generic medication can save you money? Byselecting a generic alternative you can save up to 75 percent, depending on yourprescription drug coverage and the medications involved. Although a genericmedication may differ in color, size, and shape from its brand-name counterpart, itstill has the same active ingredients. When discussing a new medication with yourdoctor, make sure to ask if a generic alternative is available. FOR MORE INFORMATION Member Services 1-800-957-6596 www.tuftshealthplan.com/enrollnow TOP 200 COVERED DRUGS
*Drug went generic during 2006, brand was moved to Tier 3 from Tier 2
Please note: A drug’s tier placement may change at any time during the year.
**Lipitor went to Tier 3 on January 1, 2007, formerly on Tier 2
Pharmacy Management Programs Medical Review Process
The list of medications covered by our pharmacy benefit is
If your doctor believes a drug included in one of our
called our formulary; there are some medications that are not
pharmacy management programs is necessary for your
covered by Tufts Health Plan. Tufts Health Plan uses a variety
treatment, the doctor may submit a request for coverage to
of programs to manage your pharmacy benefit to balance
our Clinical Review Department. We will cover the medica-
quality, safety, and affordability, while including a wide
tion if it meets our medical necessity coverage guidelines.
variety of medications in our formulary, so that you and your
If the request isn’t approved, you can appeal the decision
doctor can make appropriate decisions for your care. These
programs include the 3-tier pharmacy copayment, priorauthorization, and dispensing limitation programs.
Information on covered drugs is available on our Web site at www.tuftshealthplan.com. Just click on Pharmacy under the Members tab.
REPRODUCTIVE HEALTH CENTER MALE PATIENT HISTORY I. IDENTIFYING INFORMATION Name_______________________________ Partner's Name_______________________________ Address__________________________________________________________________________ Telephone Number – Day:( )______________ Date of Birth______ Partner's Date of Birth______ Duration of Relationship_______ Duration of Infertil