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Pharmacy
Capstone Health Plan contracts with United Drugs for pharmacy benefit management services. The United Drugs network is very comprehensive. A listing of all participating pharmacies and the Capstone Formulary can be found on the United Drugs web site.
Capstone provides an Rx Quick Reference Guide to all PCP offices for inserting into the Member/patient chart. Please be sure to refer to the formulary prior to writing a Member's prescription. Whenever possible, prescriptions should be written for the generic equivalent per the formulary.
To avoid the Member experiencing delays at the pharmacy, please contact United Drugs to obtain a prior authorization when a non-formulary medication is prescribed.
Non-Formulary Prior Authorization
All non-formulary medications require a prior authorization to be obtained through United Drugs using the Non-Formulary Authorization Request Form. Complete the entire request form and fax to the following number:
United Drugs Fax Number: (602)-678-0941
You may also contact the United Drugs Help Desk if you need further assistance at:
United Drugs Help Desk: (800) 364-8865
Please obtain prior authorization approval before the patient goes to the pharmacy.
Pharmacy Limitations
- Capstone does not cover medications that are covered by Children's Rehabilitative Services (CRS). Prescriptions written by a CRS physician for a Member enrolled in CRS are to be filled at the CRS pharmacy. CRS has a mail delivery service for Members who cannot pick up the medications at the pharmacy. CRS-covered medications are excluded from Capstone coverage; this includes prescriptions written for these medications by any physician, including the PCP. Please notify Members to obtain their CRS covered medications from CRS.
- Thirty-day limitation on coverage of phsychotropic medications prescribed that is not covered by Capstone. Please see the Behavioral Health section for additional information regarding Capstone coverage of these medications.
