Medications to assist in Treatment and Recovery
Please note: Pharmacy Services will not launch until March 2023. More information will be shared soon.
Trillium has partnered with PerformRx, a Pharmacy Benefits Manager (PBM), to oversee the pharmacy benefit plan. The PBM works with providers, care managers, and drug companies to coordinate proper medications prescribed by psychiatrists or physicians. Medications can help members improve their quality of life, experience better success in recovery, and maintain positive outcomes.
Trillium covers the drug formulary established by NCDHHS. A drug formulary is the list of generic (no brand name, such as acetaminophen instead of Tylenol®) and brand name prescription drugs covered by the Tailored Plans. In most cases, a generic drug will be prescribed, but the plan covers all brand medications if a generic substitution is not available.
Medications are classified as:
- Preferred Drug List (PDL)
- PDL non-preferred
Please see below for information on how to access medications during a disaster or emergency.
In the event of an emergency event or disaster declaration, Trillium ensures that prior authorization requirements (when appropriate) and “early refill too soon” edits are lifted for affected members. This enables members to fill an emergency supply of medications should a state of emergency be declared. This edit will assist beneficiaries should they need to fill a prescription due to a need created by a disaster and will remain in effect until the Disaster or State of Emergency Declaration is ended, or at the discretion of Trillium. This will avoid disruption in medication therapies by overriding edits that would otherwise block medication refills too soon after a previous refill or errors at point of sale and will allow pharmacies to dispense an emergency supply of medications safely and effectively for the member. In addition, affected members will be allowed, on request, to obtain the maximum extended day supply of their prescriptions.
PerformRx has a Drug Utilization Review program to prevent issues including interactions between prescribed drugs and to identify potential abuse, along with the following:
- Drug-disease contraindications (if a drug could cause more harm than benefit if diagnosed);
- Drug-drug interactions (including serious interactions with nonprescription or over-the-counter drugs);
- Incorrect drug dosage or duration of drug treatment;
- Drug-allergy interactions;
- Therapeutic appropriateness (medically necessary for the individual);
- Over- and under-utilization (whether drug is being used too frequently or not enough);
- Use of antipsychotic drugs in children and youth;
- Psychotropic polypharmacy (when more than 1 mental health medication is prescribed);
- Appropriate use of generic products;
- Therapeutic duplication (prescribing more than 1 drug for the same condition); and
- Clinical abuse or misuse.
Pharmacy Lock-In Program
The Trillium Lock-In Program helps identify members who are at risk for possible overuse or improper use of pain medications (opioid analgesics) and nerve medications (benzodiazepines and certain anxiolytics). The Trillium Lock-In Program also helps identify members who get the medications from more than one prescriber (doctor, nurse practitioner or physician’s assistant). If you qualify for this program, Trillium will only pay for your pain medications and nerve medications when:
- Your medications are ordered by one prescriber. You will be given a chance to pick a prescriber in the Trillium’s network.
- You have these prescriptions filled from one pharmacy. You will be given a chance to pick a pharmacy in Trillium’s network.
If you qualify for Trillium Lock-In Program, you will be in the program for a two-year period. If you do not agree with our decision that you should be in the program, you can appeal our decision before you are placed in the program (see Appeals page or the member handbook for more information).
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