2016 Physician Formulary Notice
Posted on December 17, 2015
Dear Provider:
The 2016 Health New England (HNE) formularies are now available online at hne.com. The online formularies are updated throughout the year as changes are made. We have three formularies, one for each of our lines of business – Commercial, Medicare Advantage, and Medicaid. Each formulary includes the tier assignment for each drug and any drug specific medication management requirements – quantity limitations, step therapy requirements, and prior authorization requirements.
When prescribing medications with drug specific medication management requirements, please use the forms available on our website at http://www.healthnewengland.com/HNE_Pharmacy/forms.html. Completing the form will ensure that we have all the information we need to make a decision. You may also contact HNE Member Services at (800) 310-2835 to request a form, or you may request prior authorization by calling our designated Prior Authorization line at (866) 209-1057.
Please consider the cost differential between each tier when prescribing. For example, under the HNE Formulary, copayments vary by plan; however, in general, the copayment differential between Tier II and Tier III is at least $30.00 per month; the difference between Tier I and III is at least $50.00 per month. By using generic drugs or prescribing therapeutic equivalents at a lower tier level, you can significantly reduce patient costs. Lower costs often translate to enhanced medication compliance. HNE covers at least one therapeutic agent for each disease state at the Tier I and Tier II levels.
We appreciate your continued partnership in providing access to high quality, affordable care to our community. If you have any questions, please call your Provider Relations representative at (413) 233-3313.
Sincerely,
Andrew Colby, RPh, MBA
Director of Pharmacy Services
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