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Pharmacy

HNE Formulary: Limitations

The formulary list was last updated on 09/01/07, please be advised the information listed may not reflect the most current data and may be updated at any time without notice.

Please call HNE Member Services at (413) 787-4000 or
(800) 310-2835 for assistance.

This section lists medications that are excluded, require prior authorizations, step therapy, or have quantity limitations. This is to ensure safe and appropriate use and to minimize potential waste of expensive medications. Only FDA maintenance indicator medications are allowed through mail-order. These lists are subject to change without notice.

Excluded Medications
The following medications are currently NOT covered by Health New England.
Prior Authorizations
The following medications require HNE's prior approval. For more information, please contact our Member Services Department at 1-800-310-2835 or 787-4004. Only FDA maintenance indicator drugs are allowed through mail order.

Step Therapy
Step therapy is an approach to medication management and is part of our Prior Authorization (PA) program. This program is designed to make the use of your prescription drugs more affordable, and we will work with your physician to provide you an appropriate drug treatment. Before claims will process and coverage is allowed, it is required that you meet the first line protocol for some or all of these medications; as indicated below. To obtain proper forms, please contact our Member Services Department at1-800-310-2835 or 787-4004.

Quantity Limitations / Quantity-based Co-payments
The following medications have quantity limitations or have quantity-based co-payments (that is, one co-payment is charged for the quantity shown below).

Note: These lists are subject to change.