Prescription Plan
Meet Your Pharmacy Advocate
Preferred Pharmacies
Drug Lookup Tool
Mail Order Pharmacy

Clinical Pharmacy Advocate

• Available to help you with any medication-related programs or concerns
• One-on-one Medication Evaluations with Members
• Works with your physician to design an affordable and effective medication regimen
• Contact the Clinical Pharmacy Advocate at (941) 748-4501 x6406 or This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Meet your Pharmacy Advocate

Dr. Christopher K. Williams, PharmD

Clinical Pharmacist

Dr. Christopher K. Williams PharmD, grew up in Plant City, Florida and received a Doctor of Pharmacy from the University of Florida. Chris is the new full time Clinical Pharmacist for the “YourChoice” Health Plan. He will assist with any medication related issues, including side effects, drug interactions, generic options, proper drug utilization and patient education. He has clinical experience in many settings, including retail, pain management, Coumadin clinics, hospitals, etc. Chris looks forward to working with the team and becoming involved in the many aspects of Manatee “Your Choice”. We welcome his expertise and experience.
 

How to Reduce Out-of-Pocket Expenses

GENERIC Medications will generally cost you less than Preferred and Non-Preferred brand medications.  Always ask your physician whether a GENERIC medication can be ordered; If not, ask if a medication from the Preferred Drug List will work for you.

A Preferred Drug List is provided to each member on a yearly basis.  You can also use the Preferred Drug Lookup Tool located on this site.

Preferred Retail Network Pharmacy Benefit

Filling your prescriptions at Preferred retail pharmacies offers you the best opportunity to save money on your prescription cost.

Your plan includes the following benefits:

• 30 Day Supply
  No co-pay for generics (free of charge to the member)
• Minimum of $10 co-pay for preferred brand medications or 20% of the approved cost
• Minimum of $30 co-pay for non-preferred brand medications or 40% of the approved cost
• Refer to the section below for Prescription Maximum Out-of-Pocket Expenses
• Preferred Network Pharmacies

• Sweetbay Pharmacies (Florida)
• Pelots (Bradenton)
• Foster Drugs (Bradenton)

Refer to Prescription Plan Home page for current directory.

Non-Preferred Retail Network Pharmacy Benefit

You can still fill your prescription at other network pharmacies, but be aware that your copay amounts will be higher than those at Preferred retail pharmacies.

Your benefits at non-preferred retail pharmacies include:

• 30 Day Supply
• Minimum of $5 co-pay for generics or  15% of the approved cost
• Minimum of $15 co-pay for preferred brand medications or 25% of the approved cost
• Minimum of $40 co-pay for non-preferred brand medications or 50% of the approved cost
• Refer to the section below for Prescription Maximum Out-of-Pocket Expenses

Mail Order Benefit

You can use mail order services offered through Prescription Solutions to fill your prescriptions. Go to the Prescription Solutions Website or call 800-562-6223 for details.

Your mail order benefits include:

• Up to 90 Day Supply
• Minimum of $12 co-pay for generics or 15% of the approved cost
• Minimum of $38 co-pay for preferred brand medications or 25% of the approved cost
• Minimum of $75 co-pay for non-preferred brand medications or 40% of the approved cost

Over-the-Counter Drug Benefit (OTC)

A 30-day supply of the following non-prescription allergy and stomach acid suppressant medications is covered as an over-the-counter prescription benefit:

• Alavert –D OTC
• Alevert OTC
• Axid OTC, Claritin OTC
• Claritin-D OTC
• Pepcid OTC
• Prilosec OTC (28 capsules)
• Tagamet OTC
• Zantac OTC

The medications listed above will be provided free-of-charge when filled at a Preferred Network Pharmacy. A $5 co-pay will apply when the prescription for the OTC drug is filled at a Non-Preferred Network Pharmacy.

You must obtain a prescription from your physician for the medications listed above. The prescription must state “OTC.”

To receive this Benefit, obtain a 30 day supply of the prescribed medication from the pharmacy shelf and take it, along with the prescription, to the pharmacist. You should then ask the pharmacist to process the claim as an “over-the-counter benefit”.

Prescription Maximum Out-of-Pocket Expense

• Only eligible prescription co-pay or co-insurance will apply to the maximum out-of-pocket expenses. Specialty Pharmacy, excess of Quantity Limits, Non Prior Authorization Approval, OTC, Plan Limitation and Exclusions are not counted toward the Maximum Out-of-Pocket Expense.
• The maximum out of pocket expense per prescription is $100 retail and $300 mail order.*
• Annual maximum prescription out of pocket expense is $1,400 per member and $2,800 per family.*

*Maximum out of Pocket Expenses can be adjusted annually by Board of County Commissioners,  refer to the annual Open Enrollment  Handbook for current values.

Prior Authorizations and Other Limitations

The computer software used by the Pharmacy Benefit Manager will evaluate the member’s medication profile and determine whether any limitations apply. It will send a message back to the dispensing pharmacist with information regarding any limitations that have been applied to the prescription. The pharmacist should supply this information to you.

Certain medications are subject to restrictions on their use. The most common restrictions are quantity limitations, age limitations, prior use of preferred medications, step therapy, prior authorizations and gender.

In the case of Prior Authorizations, the member’s physician is responsible for contacting the Manatee Clinical Pharmacist by phone, fax or email to provide the information required to complete the authorization. This process is intended to ensure the safe and appropriate use of the desired medication. Note other important information about prior authorizations and other limitations.

Prior Authorizations may take up to 72 hours or longer depending on response time from the prescribing physician. Call your Pharmacy Advocate for more information on necessary Prior Authorizations, Step Therapy, and Plan Limitations,
(941) 748-4501 x6406.

For more information regarding early refill due to vacation or business travel call
(941) 748-4501 x6412.