Is My Medication Covered?
A formulary is a list of generic and brand name drugs chosen by CHRISTUS
Health Plan and a team of doctors as part of a quality treatment plan.
These drugs are usually covered as long as the drug is medically necessary,
the prescription is filled at a network pharmacy and other rules are
Find formularies below to see if a drug is covered. If you have questions,
or call 1-844-282-3026, Monday through
Friday, 8 a.m - 8 p.m. CST.
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.
2019 Premier Performance Standard Prior Authorization (PDF)
- 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.
2019 Premier Performance Step Therapy (PDF)
- 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
What is a drug utilization review?
During a drug utilization review, we check your prescriptions and look for
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.