OSF Care Advantage Pharmacy Locator
OSF Care Advantage Online Formulary Search
OSF Care Preferred Pharmacy Locator
OSF Care Preferred Online Formulary Search

Number of Pharmacies in our network:
Nationwide: 62,513
For PPO Service Area Only: 316 (2007 total)
For HMO Service Area Only: 143 (2007 total)

Out-of-Network Information

Prescriptions that are included in the plan’s formulary (called covered drugs) must be filled at a network pharmacy in order to receive benefit coverage. However, there are extenuating circumstances for which you can obtain benefit coverage for a covered drug that is not filled at a network pharmacy.

For detailed information on out-of-network pharmacies and in what circumstances your prescriptions will be covered please refer to your Evidence of Coverage, Section 4: Prescription Drug (Part D) benefit.

Evidence of coverage books:

2008 Care Advantage Basic Rx
2008 Care Advantage Rx
2008 Care Advantage Rx Plus
2008 Care Preferred Basic Rx
2008 Care Preferred Rx
2008 Care Preferred Rx Plus

Medication Therapy Management

A Medication Therapy Management (MTM) Program is a free service we may offer. You may be invited to participate in a program designed for your specific health and pharmacy needs. You may decide not to participate but it is recommended that you take full advantage of this covered service if you are selected.

For more information about this program, please call Member Services at 309-677-8203, toll free 1-877-677-8203 or for the hearing and speech impaired (TTY) 888-817-0139.  Our business office hours are Monday through Friday 8am to 5pm. Our business phone hours are 24 hours a day, 365 days a year.

New Members

As a new member in our plan, you may currently be taking drugs that are not on our formulary or are on our formulary but your ability to get them is limited. In instances like these, you need to talk with your doctor about appropriate alternative therapies available on our formulary. If there are no appropriate alternative therapies on our formulary, you or your doctor can request a formulary exception. If the exception is approved, you will be able to obtain the drug you are taking for a specified period of time. While you are talking with your doctor to determine your course of action, you may be eligible to receive an initial 30-day transition supply of the drug anytime during the first 90 days you are a member of our plan.

For each of your drugs that is not on our formulary or for situations where your ability to get your drugs is limited, we will cover a temporary 30-day supply (unless you have a prescription written for fewer days) when you go to a network pharmacy.

After your first 30-day transition supply, we may not continue to pay for these drugs under the transition policy.

You are reminded to discuss with your doctor appropriate alternative therapies on our formulary and if there are none, you or your doctor can request a formulary exception.

If you are a resident of a long-term care facility, we will cover a temporary 31-day transition supply (unless you have a prescription written for fewer days). We will cover more than one refill of these drugs for the first 90 days you are a member of our plan. If you need a drug that is not on our formulary or your ability to get your drugs is limited, but you are past the first 90 days of membership in our plan, we will cover a 31-day emergency supply of that drug (unless you have a prescription for fewer days) while you pursue a formulary exception.

Continuing Members

As a continuing member in the plan, you should have already received your Annual Notice of Change (ANOC). You may notice that a formulary medication which you are currently taking is either not on the upcoming year’s formulary or its cost sharing or coverage is limited in the upcoming year.

In this case, you must work with your doctor to either find an appropriate alternative therapy on our new formulary or request a formulary exception prior to the beginning of the new year. If the exception request is approved, we will authorize payment prior to January 1^st and provide coverage beginning January 1^st.

If you have any questions about our transition policy or need help asking for a formulary exception, please call our Member Services Department at 309-677-8203, toll-free 877-677-8203 or for the hearing/speech impaired TTY 888-817-0139. Our business office hours are Monday through Friday 8am to 5pm. Our business phone hours are 24 hours a day, 365 days a year.

60 Day Formulary Change Letter

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