Prescription Drug Transition of Care

“How will I know if my medication is subject to coverage management (such as prior authorization, step therapy, quantity limits) under the LM HealthWorksPlan?”

The purpose of coverage management programs is to help improve the quality of care by encouraging the right patient and provider behaviors to avoid compromised care and unnecessary costs. Certain medications may require approval through a coverage review before they will be covered. This review uses plan rules based on FDA-approved prescribing and safety information, clinical guidelines, and uses that are considered reasonable, safe, and effective.

During a coverage review, Express Scripts contacts your doctor for more information before the medication can be covered under your plan.

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