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Quality Assurance | Appointing a Representative | Plan Transition Process

If you are a new member to one of our plans, and a prescription you are currently taking is not on our formulary (list of covered drugs), we can authorize that medication for the first 30 days. This is considered a transition period. We will work with you, your provider and your pharmacist to determine an appropriate alternate medication that is covered on our formulary. If your doctor cannot prescribe you an alternate medication with in the initial 30 days, FamilyCare may authorize your current medication for an additional 30 days, in which time you will need to continue to work with your provider to determine an appropriate medication. If your provider is still unable to prescribe you with an alternative medication, they can submit a prior authorization (PA) with medical documentation, stating why you need to continue to be prescribed your current medication. The PA will then be review by our Medical Director to determine if the medication requested is medically necessary.

If you have any questions about this process, please call our Customer Service Department toll free 866-798-2273 (TTY 800-735-2900), Monday - Friday 8:00am - 8:00pm. We also have extended office hours during Open Enrollment, please contat us for details.