Your Coventry Health Care Prescription Benefits
Retail Maintenance Benefit
If you take a medication on a regular basis (maintenance drug), you may be eligible to get a 90-day supply of your medication
either through the mail order program described above or through the retail maintenance program. If you obtain your
maintenance medications at a retail pharmacy instead of through the mail order, you will pay one copayment for up to a 31-day
supply1, two copayments for up to a 60-day supply1 and three copayments for up to a 90-day supply1. To take advantage of
either the mail order benefit or the retail maintenance benefit, ask your doctor to write your prescription for a 90-day supply.
Access to National Pharmacy Network
Designed to provide maximum geographic coverage, the pharmacy network consists of more than 62,000 stores in the United
States, Puerto Rico and the Virgin Islands. The national network includes national chains and independent drug stores. You can
find participating pharmacies on our website, www.chcva.com
Retail prescriptions must be filled at a participating pharmacy or a non-participating pharmacy that has agreed to accept
Medco’s reimbursement rate as payment in full.
Online Drug List
Our online Prescription Drug List will provide you with important information such as generic and preferred drug alternatives,
quantity limits and prior authorization requirements. You can also access the mail order program. To use the online formulary,
visit the Services and Support section of www.chcva.com
and click on the link for Prescription Coverage on the right
side of the page. Your plan coverage may vary slightly from the searchable formulary results. Once you have been enrolled, we
encourage you to use the pharmacy tools on Medco.com which can be accessed through My Online Services.
Transition Rx Program
Things to Remember
This program provides new members with a transition service for the first 90 • Use your member ID card when days of coverage beginning on your effective date. You may obtain a one-
filling a prescription. You may only file a claim for reimbursement for a
time fill or refill of certain covered prescription drugs, up to a 30-day supply,
at the applicable copayment without being subject to prior authorization,
step therapy and/or quantity limit requirements that normally apply to those
drugs. Coventry Health Care will then send a letter to your prescribing
provider advising that the one-time fill or refill was made available. Most
• If you take a specific medicine on a
commonly used prior authorization, step therapy and once-daily quantity
limit drugs are eligible under the Transition Rx program. Specialty injectables
and other quantity limits are excluded from the program. To find out what
drugs are subject to prior authorization, step therapy, quantity limits or other
or the Pharmacy
requirements, you may call Customer Service at 800-627-4872
Help Desk at 800-378-7040
Coventry Health Care’s program requires “mandatory” generic substitution if the FDA has determined the generic to be
equivalent to the brand-name product. If your physician requires that you take the brand-name drug instead of the generic
drug, or if you elect the brand-name rather than the generic at the point of sale, you will pay the applicable copayment plus the
difference (ancillary charge) in cost between the generic and the brand. The ancillary charge does not apply to any deductible
or maximum out-of-pocket.
Some medications on the Prescription Drug List have restrictions on the quantity that Coventry Health Care will cover.
Priorauthorization may be required if the dosage of the medication being prescribed varies from the FDA and manufacturer’s
The following services are not covered under your prescription drug benefits:
• Drugs which are not Medically Necessary.
• Allergy supplies, including syringes.
• Drugs obtained from non-participating pharmacies in a
• Experimental and Investigational Drugs; products not
non-emergency situation when such pharmacies have
approved by the FDA; drugs with no FDA-approved
not previously notified the Company, by facsimile or
indications, medications prescribed at dosages in excess
otherwise, of their agreement to accept as payment in
of FDA approval; drugs prescribed for purposes other
full reimbursement for their services at rates available to
than the FDA approved use, unless a drug is recognized
pharmacies that are Participating Providers, including any
for treatment of the covered indication in one of the
Copayment, Coinsurance and/or Deductible consistently
Standard Reference Compendia or in substantially
accepted Peer-reviewed Medical Literature. Cancer
• Any Prescription Drug which is to be administered,
drugs that are FDA approved for a certain cancer type
in whole or in part, while a Covered Individual is in a
may be used for treatment of other types of cancer,
hospital, medical office or other health care facility.
provided the drug has been recognized as safe and effective for treatment of that specific type of cancer in
• Any Prescription Drug that is being used or abused in a
any of the Standard Reference Compendia. Any drug
manner that is determined to be furthering an addiction to
approved by the FDA for use in the treatment of cancer
pain shall not be denied for coverage on the basis that
• Legend drugs for which there is a non-Prescription
the dosage is in excess of the recommended dosage
Drug alternative (such as over-the-counter) and over-
of the pain relieving agent, if the prescription in excess
the-counter (OTC) products not requiring a prescription
of the recommended dosage has been prescribed in
to be dispensed (like aspirin, antacids, herbal products,
compliance with Virginia law for a patient with intractable
oxygen, medicated soaps, food, food supplements, food
replacements, and bandages) with the exception of OTC
• Tubing for insulin pumps; Ostomy supplies, including
programs sponsored by the Company, such as Prilosec
bags, adhesives, and tubing. This is covered as stated in
Section Six of the Certificate of Insurance.
• Contraceptive implant systems and intrauterine devices
• Vitamins and minerals (both OTC and legend), except
(IUDs); Coverage for contraceptive implant systems and
legend prenatal vitamins for pregnant and nursing
IUDs are covered under Section Six of the Certificate of
females, liquid or chewable legend pediatric vitamins for
children under age 13, and potassium supplements to
• Dietary supplements, appetite suppressants, drugs used
to treat obesity or assist in weight reduction or weight
• Medical supplies other than those specifically provided
herein, medical equipment, and support garments.
• Drugs and products for smoking cessation, including
• Biological sera, and Hemophilia blood factors with the
Prescription Drugs such as Zyban and Chantix, with the
exception of programs sponsored by the Company
exception of OTC programs sponsored by the Company.
• Medications used to enhance athletic performance,
• Medications prescribed for cosmetic purposes, including
including but not limited to, anabolic steroids
but not limited to, tretinoin for aging skin and minoxidil lotion.
• Refill of prescriptions resulting from loss or theft or
resulting from damage by the Covered Individual.
• Drugs and products used to treat infertility.
• Medications for treatment of diseases of teeth and gums,
• Injectable medications, with the exception of Self-
Administered Injectable Drugs as described in this Rider or programs sponsored by the Company.
Sex, health, and years of sexually active life gained due togood health: evidence from two US population based crosssectional surveys of ageingStacy Tessler Lindau, associate professor,1,2 Natalia Gavrilova, senior research associate1with their peers in poor or fair health. Women in very goodObjectives To examine the relation between health andor excellent health gained 3-6 years compared with
PROF. FRANCESCO PURRELLO NOTE BIOGRAFICHE Nascita: POSIZIONE ATTUALE. Pofessore Ordinario di Medicina Interna presso l’Università di Catania. Direttore dell’Unità Operativa Clinicizzata di Medicina Interna dell’Azienda Ospedaliera “Garibaldi” di Catania, Presidio di Nesima PERIODI DI FORMAZIONE E DI RICERCA ALL’ESTERO - Nel Febbraio 1979, e nel Giugno-Lugli