hawk-i Wellmark Drug List

• Development of the hawk-i Wellmark Drug List

• The hawk-i Clinical Advisory Committee

• General Information

• Generic Drug Policy

• Medical Exception Requests

• Specific Exclusions and Limitations

• Medical Exception Criteria

• Search the hawk-i Wellmark Drug List

• Read more about the hawk-i Program

Development of the hawk-i Wellmark Drug List 

The hawk-i Wellmark Drug List is a tool to help manage the quality and cost of drug therapy. It should be used as a guide by providers when selecting drug therapies.

The value and effectiveness of the hawk-i Wellmark Drug List depends upon the support and compliance of providers. Thank you for prescribing formulary agents when possible. There is no cost to hawk-i members who take generic drugs. Hawk-i members are responsible, however, for the full cost of branded medications not included on the hawk-i Wellmark Drug List unless a medical exception is made. For medications not included on the hawk-i Wellmark Drug List, a medical exception process has been established for members who may require exceptions due to extreme medical situations.

The hawk-i Clinical Advisory Committee 

The hawk-i Wellmark Drug List was developed by the hawk-i Clinical Advisory Committee to develop and maintain a rational drug formulary and control pharmacy costs. The Clinical Advisory Committee is comprised of pharmacists and physicians with expertise in pediatric care.

General Information 

Drugs are listed by therapeutic classification. Providers are encouraged to prescribe generic drugs whenever possible and to use first line lower cost options when appropriate. Some drugs may be indicated for multiple conditions. In such cases, the medication is included under the therapeutic category with the most common FDA use, but will be covered when used where medically indicated.

Generic Drug Policy 

The hawk-i prescription benefit is a generic based program. If members request a brand name product when a generic product is available, the member is responsible for paying the entire cost of the branded prescription. The exceptions to this coverage include branded medications that are listed in the hawk-i Wellmark Drug List (unless a generic has been released as noted previously), brand medications excepted through the medical exception process outlined below, and the Narrow Therapeutic Index drugs listed below which are covered under this program at no charge to hawk-i members. Because generic drugs enter the market place on a frequent basis, a Brand drug that appears on this listing may no longer be covered if a generic has been introduced. For this reason, please check the Wellmark Web site for the most current list of approved drugs for hawk-i enrollees with coverage through Wellmark.

Drugs designated as Narrow Therapeutic Index Drugs may be dispensed as brand names at no cost to the member. These are as follows:

• Lanoxin
• Dilantin
• Tegretol
• Coumadin
• Synthroid
• Depakene/Depakote
• Lithium products
• Theophyline products

Medical Exception Requests 

Requests will be reviewed for Medical Exceptions on a per patient basis. This process is intended for members with severe medical situations requiring medications not covered by the hawk-i program.

Medical Exception Requests must be submitted by the prescribing physician in writing within 60 days of the denial. Requests may be faxed to 515-248-5353. The request should include: 

• The date of the request.
• The member's name.
• The member's ID number.
• The provider's name and phone number.
• A copy of the prescription.
• A brief description of the medical reason for the need of the exception.
• Medical records supporting the request.

NOTICE

^{The information contained in this formulary and its appendices is provided by Wellmark Blue Cross and Blue Shield, solely for the convenience of medical providers and members. Neither Wellmark nor the Department of Human Services warrants or assures accuracy of such information nor is it intended to be comprehensive in nature. This formulary is not intended to be a substitute for the knowledge, expertise, skill, and judgment of the medical provider in their choice of prescription drugs. Wellmark assumes no responsibility for the actions or omissions of any medical provider based upon reliance, in whole or in part, on the information contained herein. The medical provider should consult the drug manufacturer's product literature or standard references for more detailed information.}

^{The most up-to-date list of approved drugs for hawk-i enrollees is available at Wellmark.com by selecting or searching the hawk-i Wellmark Drug List.}

^{The information contained in this document is proprietary information. The information may not be copied in whole or in part without the written permission of Wellmark and the Iowa Department of Human Services. All rights reserved.}

^{Tradenames are the intellectual property of the respective product owners.}

Copyright© 2008 Wellmark, Inc. All Rights Reserved.
Wellmark Blue Cross and Blue Shield is an Independent Licensee of the Blue Cross and Blue Shield Association doing business in Iowa and South Dakota. Blue Cross®, Blue Shield®, and the Cross® and Shield® symbols are registered marks of the Blue Cross and Blue Shield Association, an Association of Independent Blue Cross and Blue Shield Plans.