Prescription Formulary and Prior Authorization Private / Group Insurance

Formulary
o Each Insurance Company has a separate Formulary
o This makes it difficult to know what medications are on what formulary
o Tier
o Most Formularies are a 3 Tier system
Tier 1: No auth needed and the cheapest
Tier 2: No auth needed more expensive than Tier 1
Tier 3: No auth needed more expensive than Tier 1& 2

o This means you may have a higher co-pay for medications on Tier 1 & 2

o Medications not on your plans Formulary

o These medications will need a prior authorization

o Prior Authorizations can take 2-7 days

o We will provide samples if available. Due to the large number or patients and limited supply of samples we will now only provide a 3 day supply of samples

o If your medication is denied you can contact the pharmaceutical companies Patient Assistant Program to obtain financial assistance. If you do not qualify for financial assistance you will need to make an individual appointment to discuss medication changes. Things we will need from you

o A list of all insurances you have

o A copy of all insurances cards

o These should be brought to every office visit

o Your pharmacies Name and Number

PRESCRIPTION POLICIES
Prescription Pick Up ti mes
****
Monday thru Thursday- 1130am- 1200pm
and 400pm- 500pm
******
****
Frida y 900am- 12:30pm
**********************
SCHEDULE II MEDICATIONS
Schedule II medications have a high potential for abuse. Use may lead to severe physical or psychological dependence. These medications must be taken as directed

o If you have reason to exceed the prescribed dosage, you must notify IPARC immediately. This will facilitate re-evaluation for increasing pain levels, and possible changes in medication or dosing instructions. Other than in the case of an emergency,
these medic ations cannot be called to you r pharmac y

o Examples of some of these types of medications are:

o Fentanyl (Duragesic Patches)

o Methadone (Dolophine)

o Sulfate (MS Contin, Oramorph)

o Oxycodone (Roxicodone, Percodan, Percocet) Please call the office approxi mat el y 3-5 da ys business days before you
are out of med icat ions we have prescribed to request refills.
This will allow our staff to review your chart and determine the appropriateness of your current medication regimen. If it is determined these medications should be continued, a renewal prescription will be called to your pharmacy except for those listed above. If you are prescribed a scheduled medication, be advised you must follow-up
with our office every thirt y (30) days for lab work and re-evaluation. Failure to attend 30 da y follow-up appointments will result in prescriptions being denied until seen. Please bring your pharmacy information with you to your appointment including the
name, address, and telephone number. This information will be necessary to process your prescriptions
, if yo u do not receive you r full prescription from the pharmac y. Please have pharmacist contact office to confir m amoun t that
was given. If you have called the nurses line for prescription refills, please allow you r call to be returned in 48 hours if not a life or limb- threatening emergenc y. Please do not leave multiple message this will only delay returning your
phone call. If you leave multiple messages you will be asked to schedule an appointment to see Dr. Leak.
DO NOT CALL FOR REFILL ON FRIDAYS. DR.LEAK IS NOT HERE
ON FRIDAYS.

Print Friendly