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 Drug Benefit Guide
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TWO-Tier Preferred Drug List
(SmartChoice / Nevada Check Up)
Introduction
As a member of Health Plan of Nevada (HPN), you have access to many useful and affordable medications. HPN uses a Preferred Drug List (PDL) to help doctors order medications you may need. Please look at your member handbook for more pharmacy benefit information.
The PDL is a list of FDA-approved generic and brand name medications suggested for use by HPN. HPN asks doctors and pharmacists to help make the list. The PDL is updated often to keep the drug list current.
Reading the Preferred Drug List
Medications are grouped together based on their category. They are then separated into drug classes. Each drug class has a section number (i.e., 1-A, 1-B, etc.). The section number is in the index.
The generic name is listed to the left of the brand name for each drug. Drugs you can get in generic form have an asterisk (*) before the brand name. Drugs that do not have a generic form are listed in BOLD print.
Certain medications may have quantity or age limitations. See your member handbook for more information.
Generic Substitution Policy
When the doctor orders a drug for you, you will get the generic form of the drug. If there isn’t a generic, you will get the brand name drug.
Pharmacy Exceptions
Members and doctors may ask Health Plan of Nevada to cover certain drugs not on the Preferred Drug List. There must be a medical reason for the request. These requests should be rare because the drugs on the list treat most illnesses.
The doctor must give HPN the reason the unlisted drug is needed. HPN uses pharmacists, doctors and/or medical guidelines to review requests. Each request is weighed on its own. Decisions are made within 24 hours of getting all needed information, with exception of weekends and holidays. The decision is sent to the member and the doctor by fax, phone, or letter. If the request is denied, the doctor or the member may appeal through the HPN appeal process.
To make a request, members may call Member Services at (702) 242-7317 or (800) 962-8074.
Take this list to all doctor appointments and check that the drug the doctor prescribes is on this list. You and your doctor should discuss the best possible treatment plan and medications you need. Because a
drug is on our Preferred Drug List does not mean that the doctor will order it.
If you have any questions about HPN’s Preferred Drug List, please call our Member Services Department at (702) 242-7317 or (800) 962-8074. We are proud to be your healthcare provider of choice. Working together, we can reach our common goal – to keep you healthy!
This summary is not an offer of coverage. If there are any differences between the information contained within this document and a specific plan document, the plan documents will govern. Participating pharmacies in our retail and/or mail-order network are independent contractors and are neither employees or agents of Health Plan of Nevada or its affiliates. This is not meant to replace the advice of a healthcare provider. This is a proprietary document and may not be copied or distributed without the express permission of Health Plan of Nevada.
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