Pharmacy (McLaren Employee Plan)
McLaren Health Advantage provides pharmacy coverage collaboratively with our pharmacy benefits manager (PBM), MedImpact. There are many benefits for both McLaren Health Advantage and the prescribing physician with using a PBM, such as alerting the pharmacist filling the prescription of:
- Drug to drug interactions
- Therapeutic duplication
- Minimum & maximum dosages
- Early refills
- What drugs are on the formulary
- If the drug being prescribed has a generic brand
McLaren Health Advantage provides different levels of copayments for generic vs. brand drugs and your member ID card lists your copay amount for your convenience.
Pharmacy Tools
Launch Drug Formulary Search Launch Drug Price Search / Pharmacy Locator
Pharmacy Management Practices
Protocols and Step Therapies are additional management procedures that are used when administering a pharmacy benefit. Sometimes a medication will require adherence to a certain Protocol or Step Therapy before it can be filled. McLaren Health Advantage’s present Protocols and Step Therapies are industry standard and provide further assurance that medications are prescribed and dispensed in the safest and clinically appropriate manner.
Time Interval Protocol
Time Interval Protocols allow Health Advantage to specify how many courses of a therapy will be allowed in a given time frame.
Step Therapies
Step Therapy Protocols allow McLaren Heath Advantage to define a logical sequence of therapeutic alternatives. This procedure controls the use of certain drugs or classes based upon previous or current drug therapy.
Daily Allowable Consumption (DACON)
This program consists of a series of dose/time therapy protocols. The DACON limits members at point of sale to no more than one tab per day of certain once daily dosed medications.
Request for Prior Authorization (Drug Exception)
McLaren Health Advantage has worked hard to provide a comprehensive formulary to meet your needs. We are aware that in certain physician directed circumstances, the formulary, Time Interval Protocols, and/or Step Therapies need special review based on your personal health history and present condition. This process allows the prescribing physicians to request a clinical review for an exception to the pharmaceutical management procedures. An approved Prior Authorization (Drug Exception) for a prescription provides coverage of the medication by McLaren Health Advantage. While the Prior Authorization process allows for clarification of the circumstances necessitating an exception, it does not change your copay amount.
Drug Side Effects and Interactions
A side effect is usually thought of as an undesirable secondary effect which occurs in addition to the desired effect of a drug or medication. Side effects may vary for each individual depending on the person's disease state, age, weight, gender, ethnicity and general health.
Side effects can occur when you start, decrease, increase or end a drug or medication. Side effects may also lead to non-compliance with prescribed treatment. When side effects of a drug or medication are severe, the dosage may be adjusted or a second medication may be prescribed. Lifestyle or dietary changes may also help minimize side effects.
When a medication works right, it boosts your health or helps you feel better. But a drug can bring on problems if it doesn't mix well with something else you put into your body, like another medication, a certain food, or alcohol. When that happens, it's called a drug interaction. It could make your medication stop working, become less effective, or act too strong in your body. It could also trigger side effects. The more you learn about drug interactions, the better you'll be able to avoid them. There are three main types of drug interactions:
Drug-drug interaction. This is when a medication reacts with one or more other drugs. For example, taking a cough medicine and a drug to help you sleep could cause the two medications to affect each other.
Drug-food/drink interaction. This is when something you eat or drink affects a drug. For instance, it can be dangerous to drink alcohol while you're on certain medications. Some vitamins and supplements interact with medicines, too.
Drug-condition interaction. This is when you have a health problem that makes it risky for you to take certain meds. For example, if you have a condition like high blood pressure, taking a decongestant for a cold could drive up your blood pressure event more.
Talk to your doctor or pharmacist if you have questions about side effects or drug-drug interactions.