The Preferred Product Program allows Funds’ beneficiaries to obtain “preferred” medication products from select classes. “Non-preferred” products may be obtained through doctor’s request.
If a beneficiary cannot take a preferred product due to a specific medical reason(s), their doctor can request medical necessity for the non-preferred drug. If the drug is approved the beneficiary will receive the product for their usual copayment.
The program is administered in two different ways, depending on which plan the beneficiary is enrolled in.
For only beneficiaries under American Consolidated Natural Resources Plans, Crimson Oak Grove Resources Plans or UMWA International Plan:
The Supplemental Formulary Preferred Product Program requires a prior authorization from the doctor for approval.
Review Supplemental Formulary Preferred Product Program Drug List here.
Review Medical Necessity “Prior Authorization” Form here.
For all beneficiaries except those under American Consolidated Natural Resources Plans, Crimson Oak Grove Resources Plans or UMWA International Plan:
The Supplemental Formulary Preferred Product Program allows for a surcharge or the doctor can submit a medical necessity request
Review Standard Formulary Preferred Product Program Drug List here.
Review Medical Necessity “Prior Authorization” Form here.
If you are unsure about which plan the patient holds, please contact our call center at 1-800 291-1425
