Formulary (Drug List)
2019 Transition Policy
ATRIO PPO Plans
ATRIO Special Needs Plans
The formulary may change at any time. You will receive notice when necessary.
ATRIO Health plans uses a comprehensive formulary. A comprehensive formulary
is a complete list of covered drugs selected by ATRIO Health Plans in
consultation with a team of health care providers, which represents the
prescription therapies believed to be a necessary part of a quality treatment
program. ATRIO Health Plans will generally cover the drugs listed in our
formulary as long as the drug is medically necessary, the prescription
is filled at an ATRIO Health Plans network pharmacy, and other plan rules
are followed. For more information on how to fill your prescriptions,
please review your Evidence of Coverage (Member Handbook).
Can the Formulary change?
Generally, if you are taking a drug on the current plan year formulary
that was covered at the beginning of the year, we will not discontinue
or reduce coverage of the drug during the rest of the coverage year except
when a new, less expensive generic drug becomes available or when new
adverse information about the safety or effectiveness of a drug is released.
Other types of formulary changes, such as removing a drug from our formulary,
will not affect members who are currently taking the drug. It will remain
available at the same cost-sharing for those members taking it for the
remainder of the coverage year. We feel it is important that you have
continued access for the remainder of the coverage year to the formulary
drugs that were available when you chose our plan, except for cases in
which you can save additional money or we can ensure your safety.
If we remove drugs from our formulary, or add prior authorization, quantity
limits and/or step therapy restrictions on a drug, we must notify affected
members of the change at least 60 days before the change becomes effective,
or at the time the member requests a refill of the drug, at which time
the member will receive a 60-day supply of the drug. If the Food and Drug
Administration deems a drug on our formulary to be unsafe or the drug’s
manufacturer removes the drug from the market, we will immediately remove
the drug from our formulary and provide notice to members who take the drug.