Please read the following information about prescriptions and pharmacy benefits. For a print version, click here
Some prescription drugs may require prior approval before your prescription can be filled. Your physician’s office will need to send a Prior Authorization form to Pharmacy Benefit Dimensions for review. The physician simply faxes this request to Pharmacy Benefit Dimensions where it will be reviewed and a response is generally provided within 24 hours. If your physician does not have a copy of the Prior Authorization request form, they can obtain a copy by calling Pharmacy Benefit Dimensions’ Prior Authorization Department at (716) 631-2934 or 1-800-993-9898 extension 5311.
Some prescription drugs are restricted by age due to safety reasons or Food and Drug Administration (FDA) recommended labeling.
In some cases, you may be required to first try certain drugs to treat your medical condition before we cover another drug for that condition. This is called Step Therapy. Step therapy is a way to help you get the best quality and value from your prescription drug benefit. This usually means that an equally effective drug be prescribed before a more expensive brand name drug. Step therapy may also ensure that two medications are used together if they are more effective.
Quantity limitations may apply to certain medications. Some medications are covered up to a specific quantity per 30 or 90 days. Some examples of medications with a quantity limitation are: sumatriptan (generic Imitrex®) and zolpidem tartrate (generic Ambien®).
Maximum Daily Dose (MDD)
Certain drugs are dose limited by a maximum daily dose (MDD) as recommended by the Food and Drug Administration (FDA) for safety reasons. Limits may be set by the number of tablets/capsules per day or the total daily dose.
Over-the-Counter (OTC) medications
The Food & Drug Administration (FDA) periodically reviews prescription drugs for over-the-counter distribution. This does not mean that these drugs are less than effective. The FDA merely determines they are safe to be sold without the supervision of a physician. Your plan covers select over-the-counter medications in accordance with the Pharmacy Benefit Dimensions prescription drug formulary, with a written prescription by your physician.
If you have any questions at the time you are going to pick up your prescription, please have your pharmacist contact our Pharmacy Help Desk at 1-800-993-9898. Most often these problems can be resolved while you are at the pharmacy. If the problem is not resolved at the pharmacy please call the Pharmacy Benefit Member Services phone number 716-635-7880 or 1-888-878-9172 which is listed on the back of your ID card.