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Project Access Formulary Information
All prescriptions for Project Access Dallas patients are filled by Caremark. Caremark is the largest pharmacy benefits manager in the United States, with more than 40,000 retail pharmacies. When a patient is enrolled in Project Access Dallas, he is given a Caremark medications assistance card, which is honored by participating pharmacies in Dallas County. While he is enrolled in Project Access Dallas, he can receive prescribed medications for $10, if the medication is on the PAD formulary. The patient pays $10 per prescription and PAD pays the remaining amount of the pharmacy charge. In an attempt to make the patient’s pharmacy benefits last longer, effective January 1, 2004, our Project Access Dallas formulary became a generic-only formulary. Although most of the medical services are donated to Project Access Dallas, one that is not is the pharmacy piece of the program which, as you can imagine, is tremendously expensive. This means the project will pay for only medications that are NOT brand names. Additionally, we are asking, when possible, for you to provide sample drugs to the patients. The formulary rejects all brand single/multi-source drugs and allow generics only to be processed. The only exception to the generic only formulary will be for brand insulin (which, includes brand Insulin/Insulin cartridges used in pen-devices/ Insulin prefilled syringes). For a request to have a brand drug authorized over a generic
please fill out the Brand
Over Generic Request Pharmacy Benefits Maximum So we can serve as many Project Access Dallas patients as possible, there is $750 per year maximum pharmacy benefit, per enrollee, on what the project will pay in pharmacy costs. That means once a patient has reached their$750 pharmacy limit, the patient must pay for all their medications. Project Access Dallas pharmacy benefits are managed on a calendar basis -- from January 1, 2008, through December 31, 2008. That means that if the patient goes over their $750 maximum pharmacy benefit before December 31, 2008, their pharmacy benefits will not be turned back on until January 1, 2009– and, only if their enrollment in the program is still active. Once our Pharmacy Benefits Manager has identified that a patient has exceeded the $750 per year maximum, the patient is sent a letter and given 30 days from the date of the letter to pay for filling and refilling his prescriptions. The patient still will be enrolled in the Project Access Dallas program until his six-month enrollment cycle ends. For the remaining of the patient’s six-month enrollment cycle, the patient will still have access to the Project Access Dallas network, which includes a comprehensive list of physicians, hospitals, mental health services, ancillary service providers (such as diagnostic radiology centers), and pathology and laboratory services. When a patient exceeds the limit, he is sent a letter telling him to:
We know you understand that costs of medicines are high, and we are grateful for the funding that provides all Project Access Dallas enrollees access to limited pharmacy benefits. If you have any questions regarding the formulary, please contact the Project Access Dallas medical director, Jim Walton, DO, at 972-860-8606 or Connie Webster, director of Project Access Dallas/community health, at 214-413-1426 or 214-948-3622, Ext. 226 or email connie@dallas-cms.org.
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