Horizon NJ Health covers many medications that are offered to you at a low cost. These approved drugs make up our formulary.
If your doctor wants to prescribe a drug that is not included in our formulary, he or she will need to call us to get prior authorization, or approval in advance.
It is important that the medications you take are safe and effective. That is why Horizon NJ Health has a committee made up of practicing doctors and pharmacists that reviews and approves our formulary.
Certain over-the-counter (OTC) products are covered with a written prescription from the prescriber (for example, Loratadine, Alaway, Zaditor OTC, Omeprazole, Lansoprazole, smoking deterrents). Some medications are not covered under your pharmacy benefit including, but not limited to: fertility agents, weight loss drugs and erectile dysfunction medications. For members residing in a long-term care facility, OTC medications are generally provided by the institution, rather than via the Horizon NJ Health pharmacy benefit.
The Approved Drug List (formulary) is updated annually and as changes are made or new medications are approved. The Approved Drug List is updated as of the date that formulary changes are put in place. Changes to the Approved Drug List are included in the member newsletter mailed to all members.
- Covered pharmaceuticals are in the “Approved Drug List” below.
- Copayment: The amount a person must pay for a health care service at the time the service is given.
The copayments for prescription drugs (retail pharmacy) are:
|NJ FAMILYCARE A||$0|
|NJ FAMILYCARE ABP||$0|
|NJ FAMILYCARE B||$0|
|NJ FAMILYCARE C||$1 for generic drugs
$5 for brand-name drugs
|NJ FAMILYCARE D||$5 for generic and brand-name drugs
$10 if greater than a 30-day supply
- Pharmaceuticals that require prior authorization are noted in the “Approved Drug List” below.
- Please note that Horizon NJ Health maximum days supply limit is 30 days.
If you have any questions, please call the Horizon NJ Health Pharmacy Department toll free at 1-800-682-9094.