D.C. Chartered Health Plan, Inc. offers its Chartered Managed Care Formulary 2007 for use when prescribing for patients covered by the pharmacy plan offered by Chartered. This is a closed formulary and only those drugs listed in the formulary will be covered by Chartered Health Plan. There is no co-payment for members when prescribed medications from this formulary.

Drugs listed in the Chartered Health Plan Managed Care Formulary have been reviewed and approved by the Chartered Health Plan Pharmacy and Therapeutics (P&T) Committee. The P&T Committee is made up of local physicians, pharmacists and nurses. The actions of the Committee are communicated in a quarterly provider newsletter distributed to all physicians who received the Chartered Health Plan Managed Care Formulary. Updates can also be found on the Internet at http://www.chartered-health.com

Medical Exception

Medical exception will be granted for members who have had one of the following:

	Documented allergy/allergic reaction to formulary agents.
	Documented failure on formulary agents.
	Documented patient stability/control issues where change to a formulary agent is contraindicated or not advisable.

To request a medical exception:

	The prescriber should call 1800-408-7510 to notify the Utilization Management Department of the desire for a non-formulary medication;
	A Pharmacy Override Form will be faxed to the prescriber to complete and return to the Chartered Health Plan Medical Management Team;
	If the medication is denied, prescriber may appeal to the Medical Director.
	In the event of an emergency, a 72-hour supply of medication will be available to the patient.

Chartered Managed Care Formulary 2007