Akron General EHP – Prescription Drug Benefits

The 2020 SPD and Prescription Drug Handbooks are currently being updated.  In the interim, the charts below are the benefit summaries for the Medical and Prescription Drug benefits.  For further questions please contact cehpao@ccf.org

Pharmacy Handbook

July 2020 Drug Formulary 

Maintenance Drug List

EHP Prescription Drug Formulary Updates for September 2020

Cleveland Clinic EHP Summary of Benefits and Coverage (SBC) click here

The appropriate, cost-efficient use of pharmaceutical therapies can be an effective strategy for improving your health and healthcare expenses.  Akron General’s EHP Prescription Drug Benefit provides members with medications based on each drug’s effectiveness, safety and value.  The Prescription Drug Benefit program is administered through CVS/caremark, which offers reimbursement on prescriptions you must pay upfront.  

Cleveland Clinic Pharmacies Enhanced Benefit

Akron General EHP members have the option of paying a lower percentage co-payment for their prescriptions by using one of the following Cleveland Clinic Pharmacies or the Akron General Pharmacy

For your convenience, EHP also offers a home delivery service through the Cleveland Clinic Home Delivery Pharmacy.  To get started, please visit the Cleveland Clinic Home Delivery Pharmacy MyRefills website where you can set up your account, change your billing information and shipping address, or check on the status of your order.  Please call 216.448.4200 for questions or additional information on the Cleveland Clinic Home Delivery Pharmacy.



CVS/Caremark Prescription Reimbursement Claim Form

To be used when you must pay for a prescription up-front.  Complete the claim form for reimbursement through CVS/Caremark click here. 

Prior Authorization/Formulary Exception

Prior authorization is necessary for coverage of certain medications.  These medications are listed in the Cleveland Clinic EHP Drug Formulary Book.  The medicines on the list may change throughout the year due to FDA approvals of new drugs or new indications are established for previously approved drugs.  A Prior Authorization/Formulary Exception Form must be completed or sufficient documentation must be submitted before a case will be reviewed.

Statin Medications for Primary Prevention of Cardiovascular Disease:  As of January 1st, 2018, under the provisions of the Affordable Care Act mandate regarding cardiovascular disease preventive health services, generic formulary low to moderate dose statins will be covered under the EHP Prescription Drug Benefit at no member out-of-pocket expense within specific coverage guidelines.  To begin this process, please have the prescribing provider submit a Statin Formulary Exception Questionnaire to the Employee Health Plan Pharmacy Management Department.  All requests must meet the clinical criteria approved by the EHP Pharmacy and Therapeutics (P&T) Committee before approval is granted.  Additional information can be found in the EHP Drug Formulary Book (link above).  Download the Statin Formulary Exception Questionnaire by clicking here
Disclaimer:  All requests must meet the clinical criteria approved by the Pharmacy and Therapeutics (P&T) Committee before approval is granted. In some cases, approvals will be given a limited authorization date. If a limited authorization is given both the member and the physician will receive documentation on when this authorization will expire. Most requests will be processed within 1-2 business days from the time of receipt. A response will be faxed to the requesting physician, and the member will be informed of the request and the decision via mail.