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.
- Copay: The amount a person 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||$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.
Managing your medication
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 medication. With multiple daily medications, it can sometimes be difficult to remember to take them as directed, or even make sure you have all of your medications available when you need them. Taking your medication correctly is key in managing your health condition.
What you can do to manage your medication
• Talk to your doctor – review all of your medicines (including prescription, over-the-counter (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 your medication. 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 medication you take and helps them manage your care.
If you have any questions about your medication, talk to your doctor or pharmacist.