This Benefit Guide was approved by the Pharmacy & Therapeutics Subcommittee on July 1, 2013.
General Program Guidelines
This program is administered by the UIHC Department of Pharmaceutical Care Ambulatory Care Pharmacies in conjunction with Wellmark formulary guidelines.
1. Prescription medications, if medically necessary, are available for house staff members or their immediate family member, defined as a spouse or child living with the house staff member. Members and their covered family members should present their Wellmark identification card to the pharmacy, or have their Wellmark ID number available.
2. Medications will be covered using the Wellmark Pharmacy “tiers”. Coinsurance (patient’s responsibility) is determined by a combination of the medication’s tier and pharmacy service location:
| Drug Tiers | Coinsurance at UIHC Pharmacy Locations | Coinsurance at Outside Pharmacy Locations |
|---|---|---|
| Tier 1 (most generic medications) | $0 | 25% coinsurance |
| Tier 2 | 15% coinsurance | 30% coinsurance |
| Tier 3 | 35% coinsurance | 50% coinsurance |
| Tier 4 (not covered) | 100% coinsurance | 100% coinsurance |
Payment for coinsurance will be due at the time of service.
3. Wellmark prior authorization and quantity limit criteria will apply to all prescriptions.
4. A clinician may not prescribe medications for himself or herself in accordance with the Hospital Policy MS-SOP-01.21. In general, prescriptions should be issued as part of a clinic visit. This is consistent with expectations of the Board of Medical Examiners, the AMA, and hospital guidelines. Over-the-counter medications (with the exception of pseudoephedrine products, per Iowa law) may be self-prescribed.
5. Hospital policy and state law require that prescriptions for all controlled substances written for immediate family or personal use must be written by a clinical faculty member. All prescriptions for controlled substances must include an appropriate DEA registration number. Effective May 21, 2005, most pseudoephedrine-containing products sold in Iowa (including all such products stocked by University Hospitals) are handled as Schedule V controlled substances.
6. To assure safe prescribing, legal compliance, and avoidance of the potential for dangerous drug interactions, all prescriptions should be generated from the Epic medical record if written by a UIHC prescriber. Prescriptions must reflect the complete name of the patient for whom the medication is being prescribed, hospital number, birth date, date written, and the indication for use.
7. Prescription drug use will be monitored on an ongoing basis to detect potentially excessive utilization of medications (whether restricted or unrestricted) by house staff physicians and dentists. Individuals with unusually high rates of prescription drug utilization (for themselves or their dependents) may be contacted to provide additional information on the circumstances influencing their prescribing practices.
8. To minimize waiting time for clinic and discharge patients, house staff are asked to plan ahead so that refills and new prescriptions for non-urgent medications are presented one day and picked up the following day.
9. Prescription refills may be requested by phone at 384-6800.
10. Questions regarding a bill/statement may be referred to the Pharmacy Business Office at 353-7516.
11. If receiving high cost self-injectable medication (covered under medical) 10% of the co-pay must be paid at the time of service; the balance may be placed on account with the pharmacy billing office. Signing of a Pharmacy Financial Agreement is required. Failure to pay the balance within one week of receiving insurance reimbursement will result in the balance being deducted from monthly payroll.