The approved prescription drugs that Horizon NJ Health covers make up our formulary. It’s important that the medicine you take is safe and effective. That’s why Horizon NJ Health has a committee made up of doctors and pharmacists who review and approve 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. A prior authorization is an approval that the doctor needs to get from us before we cover the cost.
Certain over-the-counter (OTC) products are covered with a written prescription from the prescriber. Some medicines are not covered under your pharmacy benefit. This includes, but not limited to, fertility agents, weight loss drugs and erectile dysfunction medicines. Members who live in a long-term care facility will usually get their OTC medicines from the facility, rather than through the Horizon NJ Health pharmacy benefit.
The Approved Drug List (formulary) is updated annually and as changes are made or new medicines 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 that we mail to all members.
- Covered drugs are in the Approved Drug List below.
- Copay: The amount a member must pay for a health care service at the time the service is given.
The copays 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||$1 for generic drugs
$5 for brand-name drugs
- Drugs that require prior authorization are noted in the Approved Drug List below.
- Please note that Horizon NJ Health maximum day 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 x81016 (TTY 711).
You, or your provider on your behalf, can submit a prior authorization exception request by completing the Prior Authorization Request Form and mailing or faxing it to our Pharmacy Department. Please follow the instructions on the form.
If you need help or have questions about this form, please call the Horizon NJ Health Pharmacy Department at 1-800-682-9094 x81016 (TTY 711). You can also use Contact Us function when you sign into the secure member web portal.
Managing your medicine
If you take prescription drugs to manage your chronic condition like diabetes or asthma, you should take the necessary steps to make sure you are managing your medicine. With multiple daily medicines, it can be difficult to remember to take them as directed, or even to make sure you have them all available when you need them. Taking your medicines correctly is key in managing your health condition.
What you can do:
- Talk to your doctor – review all of your medicines (including prescription, OTC and herbal) and let your doctor know if you are experiencing any side effects, like dizziness.
- Talk to your pharmacist – make sure you understand the instructions for taking your medicines.
- Take as directed – take all of your medicines exactly as the label says to make sure they work the right way to treat your condition.
- Refill your prescriptions timely – refill your prescription before you run out of medicine. You can also ask your pharmacy about automatic refills so your medicine is always refilled and ready for you.
- Fill all of your prescriptions at the same pharmacy – this allows your pharmacist to see all the medicines you take and helps them manage your care.
If you have any questions about your medicines, talk to your doctor or pharmacist.