Drug Name Search Results | Formulary Search

Selection

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Therapeutic Class Search: gastrointestinal agents/protectants

3 drug(s) found

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Results

Brand Name Generic Name	Therapeutic Class Sub-Class	Dose/Strength	Status	Notes & Restrictions
MISOPROSTOL ORAL TABLET 100 MCG Gastrointestinal Agents Protectants	Gastrointestinal Agents Protectants	TABLET 100 mcg
MISOPROSTOL ORAL TABLET 200 MCG Gastrointestinal Agents Protectants	Gastrointestinal Agents Protectants	TABLET 200 mcg
SUCRALFATE ORAL TABLET 1 GRAM Gastrointestinal Agents Protectants	Gastrointestinal Agents Protectants	TABLET 1 gram

Definition of Status

Icon	Status	Definition
	Tier 1	This is the lowest cost sharing tier that includes preferred generic drugs. Details about your specific benefit for each tier are included in your Summary of Benefits.
	Tier 2 Generic	This tier includes generic drugs.
	Tier 3 Preferred Brand	This tier includes preferred brand name drugs and some higher cost generic drugs.
	Tier 4 Non-Preferred Drug	This tier includes brand name drugs and some higher cost generic drugs.
	Tier 5 Specialty	This is the highest cost sharing tier that includes brand name and generic drugs.
	Non-Formulary	Your drug is not listed on the Formulary (Drug List). You can try to find a covered formulary alternative in the same therapeutic class. If this is not an option and the drug is not excluded under Medicare Part D, you can request an exception. Exceptions are not granted for excluded Part D medications. To find out how to request a formulary exception, click here.

Definition of Restrictions

Icon	Restriction	Definition
	Attention!	This note will have additional information regarding the drug.
	Generic Indicator	This is a generic drug. A generic drug is approved by the FDA as having the same active ingredient as the brand name drug. Generally, generic drugs cost less than brand name drugs.
	Limited Access	This prescription may be available only at certain pharmacies. For more information consult your Pharmacy Directory or contact Health First Health Plans Customer Service at 1.800.716.7737 or, for TTY users, 1.800.955.8771, weekdays from 8 a.m. to 8 p.m. and Saturdays from 8 a.m. to noon. From October 1 through February 15, we are available seven days a week from 8 a.m. to 8 p.m. or visit myHFHP.org.
	Prior Authorization	Health First Health Plans requires you or your physician to get prior authorization for certain drugs. This means that you will need to get approval from Health First Health Plans before you fill your prescriptions. If you do not get approval, Health First Health Plans may not cover the drug.
	Prior Authorization - New Starts	Health First Health Plans requires you or your physician to get prior authorization for certain drugs. This means that you will need to get approval from Health First Health Plans before you fill your prescriptions. If you do not get approval, Health First Health Plans may not cover the drug. Prior authorization for this drug applies to new starts only.
	Prior Authorization- Part B vs. Part D	This prescription drug has a Part B versus Part D administrative prior authorization requirement. This drug may be covered under Medicare Part B or Part D depending upon the circumstances. Information may need to be submitted describing the use and setting of the drug to make the determination.
	Quantity Limit	For certain drugs, Health First Health Plans limits the amount of the drug that will be covered. For example, “30 EA per 30 days” would mean your coverage of this drug is limited to 30 pills every 30 days, or 1 pill per day.
	Step Therapy	In some cases, Health First Health Plans requires you to first try certain drugs to treat your medical condition before we will cover another drug for that condition. For example, if Drug 1 and Drug 2 both treat your medical condition, Health First Health Plans may not cover Drug 2 unless you try Drug 1 first. If Drug 1 does not work for you, Health First Health Plans will then cover Drug 2.