Pharmacy Services and Drug Formulary
Medications to Help in Treatment and Recovery
Trillium has partnered with PerformRx, to oversee the pharmacy benefit plan. They work to provide access to medications prescribed by psychiatric and physical health prescribers. Medications can help members improve their quality of life, experience better success in recovery, and see positive outcomes.
Trillium covers medications on the drug formulary established by NCDHHS. A drug formulary is the list of generic (such as acetaminophen instead of Tylenol®) and brand name prescription drugs covered by the Tailored Plans. In most cases, a generic drug will be required to be dispensed, but the plan covers all brand medications if a generic substitution is not available. Medications are classified on the Preferred Drug List Preferred (PDL) as Preferred, Non-Preferred or Non-PDL.
Members can call Member and Recipient Services at 1-877-685-2415 for printed version of the drug formulary to be mailed to them or to ask questions.
The searchable formulary below is updated each day. You can search the formulary for prescription limits, medications requiring prior authorization, and more:
Pharmacy Locator
In the event of an emergency event or disaster declaration, Trillium will make sure members can fill an emergency supply of medications. Certain members will also be able to get the maximum extended day supply of their prescriptions. Your care manager will share more information with you about this.
Use the pharmacy location tool to find a pharmacy near you:
PHARMACY BENEFITS
- Prescription drugs.
- Some medicines sold without a prescription (also called “over-the-counter”), like allergy medicines.
- Insulin and other diabetic supplies like syringes, test strips, lancets and pen needles.
- Items to help stop smoking, including over-the-counter products.
- Emergency contraception.
Note: There is a $4 copay for generic and brand prescriptions if you have Medicaid
Providers and members will be notified annually and after the State implements changes, and/or when there are new/changes to pharmacy management procedures. Members and providers will be given information on how to:
- Access to the Preferred Drug List, including any restrictions, requirements for generic substitution, therapeutic interchange and step-therapy protocols.
- Request a prior authorization. Members and providers also will be notified where to find prior authorization criteria, and how to provide information to support an exception request.
- An explanation of limits or quotas.
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 covered 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 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 the 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 the Appeals page or the member handbook for more information).
Trillium Health Resources members will be enrolled into the lock-in program for a minimum of two (2) years if one or more of the following criteria are met:
Member has received ten (10) benzodiazepine prescriptions within two (2) consecutive months when not medically necessary.
Member has received ten (10) opiate (pain management) prescriptions within two (2) consecutive months when not medically necessary.
Member is receiving prescriptions for opiates and benzodiazepines from four (4) or more prescribers in two (2) consecutive months when not medically necessary.
Locked-in members will be restricted to one prescriber and one pharmacy at minimum for prescriptions for benzodiazepines and opiates. These requirements apply only to those drugs, for members who are in the lock-in program.