Pharmacy Part D

As a member of CHRISTUS Health Plan Generations or Generations Plus you have prescription drug coverage for Medicare Part D in addition to medical and hospital benefits.

To see if CHRISTUS Health Plan covers a prescription drug, please call member services at 1-844-282-3026. To keep costs low for members and reduce medication errors, we use utilization management practices and drug utilization reviews. Read more about these practices below.

2019 Generations/Generations Plus Formulary

What is utilization management?

Utilization management is a practice where some medical services and drugs are evaluated for need before they can be used. This means that for certain prescription drugs, special rules restrict how and when the plan covers them. A team of doctors and pharmacists developed these rules to help members use drugs effectively and keep coverage affordable. Examples of utilization management include:

  • Prior Authorization: We may require you to get approval from us before you fill certain prescriptions. If you don’t get approval, we may not provide coverage for the drug.
  • Quantity Limits: We may limit or only cover a certain amount of a drug per prescription or for a period of time.
  • Step Therapy: In some cases, members may need to try one drug to treat their condition before we will provide coverage for another drug.
  • Generic Substitution: When a generic version of a drug is available, our pharmacies will automatically give members that version unless your doctor has told us that you must take the brand name drug.

You can find out if your drug is subject to these additional requirements or limits by looking in our formulary. If your drug does have additional restrictions or limits, you can ask us to make an exception to our coverage rules.

What is a drug utilization review?

During a drug utilization review, we check your prescriptions and look for problems like:

  • Possible medication errors
  • Duplicate drugs that are unnecessary
  • Drugs that are inappropriate because of your age or gender
  • Possible harmful interactions between drugs you are taking
  • Drug allergies or dosage errors

These reviews are especially important if you have multiple doctors who prescribe medications. We conduct reviews each time you fill a prescription and on a regular basis. If we see a problem during our review, we will work with your doctor to correct it.


Disclaimer
CHRISTUS Health Plan Generations is an HMO plan with a Medicare contract. Enrollment in CHRISTUS Health Plan Generations depends on contract renewal. You must continue to pay your Part B premium. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Other pharmacies/physicians/providers are available in our network. Medicare beneficiaries may also enroll in CHRISTUS Health Plan Generations (HMO) through the CMS Medicare Online Enrollment Center located at medicare.gov. A sales person will be present with information and applications. This information is available for free in other languages. For accommodations of persons with special needs at sales meetings, call 1-844-282-3026, TTY call 711. Open seven days a week, 8:00 a.m. to 8:00 p.m., local time, from October 1 – March 31, and Monday – Friday, 8:00 a.m. to 8:00 p.m., local time, from April 1 – September 30. A voice response system is available after hours as well as Thanksgiving and Christmas Day. Messages left will be responded to within one (1) business day. CHRISTUS Health Plan Generations (HMO) Contract #H1189.

Notice
CHRISTUS Health Plan does NOT require authorization for in-network behavioral health services. If you have any questions, please call Member Services at:

Member Services: 844-282-3026