Exclusive Pharmacy and Provider Assignment

Members who are taking certain medications are reviewed to make sure that it is the right medication at a safe dose. Some of the medications that are included in this review are:

• Opioids (for pain)
• Benzodiazepines (for anxiety)
• Muscle relaxants
• Hypnotics (for sleep)
• Stimulants
• Atypical antipsychotics

This review occurs every three months. Members may be limited to one pharmacy and/or one provider for these medications. Some of the reasons why this would occur include:

• If you fill four or more different types of these medications, have four or more doctors prescribing these medications, and use four or more pharmacies to fill these medications within three months 
• You fill 12 or more prescriptions for one of these medications within three months
• A forged or altered prescription is used at the pharmacy 

Assignment to a specific provider or pharmacy is in place for 12 months. It will then be reviewed to see if it is still needed. You would be notified in writing before this assignment occurs. You will have the right to appeal this decision. If you are assigned to a specific provider and/or pharmacy and need a medication in an emergency situation, you can contact B – UFC/ALTCS Customer Care Center to help with this.

You may be excluded from this requirement if you have certain conditions including:

• Cancer
• You are in hospice care
• You are in a skilled nursing facility