Drug Coverage

The drugs covered by RiverSpring FIDA Plan, including prescription and over-the-counter drugs and any restrictions, are described on the List of Covered Drugs . You generally must use pharmacies in the RiverSpring FIDA Plan network to obtain your medications.

Formulary

2019

2018

The Drug List and pharmacy and provider networks may change from time to time throughout the year and on January 1 of each year. You can always check RiverSpring FIDA Plan’s up-to-date List of Covered Drugs online at www.RiverSpringFIDA.org or by calling RiverSpring FIDA Plan Pharmacy Services toll-free at 1-855-898-1482. If there is a change to coverage for a drug you are taking, we will send you a notice. Normally, we will let you know at least 60 days before the change.

Limitations and restrictions may apply. For more information, call RiverSpring FIDA Plan Participant Services or read the RiverSpring FIDA Plan 2019 Participant Handbook, 2018 Participant Handbook

Restrictions and Limitations on Drug Coverage

Some drugs have coverage rules, or limits on the amount you can get. In some cases, you must do something before you can get the drug.

Prior authorization: For some drugs, you or your doctor must get approval from RiverSpring FIDA Plan or your IDT before you fill your prescription. For details, please read our Prior Authorization Criteria:

2019 Prior Authorization Criteria
2018 Prior Authorization Criteria

Quantity limits: The amount of a drug that you can get may be limited. Please refer to the List of Covered Drugs for details.

Step therapy: Sometimes, you will have to try drugs in a certain order for your medical condition. You might have to try one drug before we will cover another drug. For details, please read our

2019 Step Therapy Criteria.
2018 Step Therapy Criteria.

Prescription Drug Transitions

In some cases, the plan can give you a temporary supply of a drug when the drug is not on the Drug List or when it is limited in some way. This gives you time to talk with your provider about getting a different drug or to ask RiverSpring FIDA Plan or your IDT to approve the drug.

During the first 90 days of your membership in RiverSpring FIDA Plan, we will cover a temporary supply (or supplies) of your drug for up to 90 days if you do not live in a long-term care facility, or up to 98 days if you live in a long-term care facility.

If you have been a participant in our plan for more than 90 days, live in a long-term care facility, or have been admitted or discharged from a hospital or long-term care facility, and need a supply right away, then we will cover a 31 day supply, or less if your prescription is written for fewer days. For details, please read our Drug Transition Policy.

To ask for a temporary supply of a drug, you or your appointed representative, or the prescriber may call RiverSpring FIDA Plan Pharmacy Services toll-free at 1-855-898-1482 or fax the request to 1-855-898-1483.

 

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This page was last updated on October 17, 2018 09:30:00 EST