![]() Prior authorization for this drugįor certain drugs, The Plan limits the amount of the drug that will be covered. For example, “30 EA per 30 days” would mean your coverage of this drug is limited to 30 pills every 30 days, or 1 pill per day. If you do not getĪpproval, The Plan may not cover the drug.Īpproval, The Plan may not cover the drug. This means that you will need to getĪpproval from The Plan before you fill your prescriptions. The Plan requires you or your physician to get Maintenance medications are generally those used to treat chronic conditions and long-term conditions. To convert thyrotropin level to micrograms per liter, multiply. You may be taking these drugs on a long-term basis. Thyroid hormone levels after 6 and 12 weeks of morning or bedtime intake of levothyroxine sodium. Generic drugs cost less than brand name drugs. A generic drug is approved by the FDAĪs having the same active ingredient as the brand name drug. ![]() for Health First Health Plans' or 1.844.522.5279 ![]() To find out how to request a formulary exceptionġ.855.443.4735 (TTY/TDD relay: 1.800.955.8771) Monday through Friday from 8 a.m. Depending on your diagnosis and doctor recommendation, typical dosages of levothyroxine for hypothyroidism include: 25 mcg 50 mcg 75 mcg 88 mcg 100 mcg 112 mcg 125 mcg 137 mcg 150 mcg 175 mcg 200 mcg 300 mcg The less thyroid hormone that your body naturally produces, the higher your prescription drug dosage will likely be. You can try to find a coveredįormulary alternative in the same therapeutic class. This tier includes some select preventive products, prescription medications and specific over-the-counter (OTC) medications available to you at no cost-sharing ($0) when applicable conditions are met.ĭrug is not listed on the Formulary (Drug List). Limited to a 30-day supply. Details about your specific benefit for each tier are included in your Summary of Benefits. THYRONORM 88MCG contain Levothyroxine sodium which is a synthetic thyroid hormone and is chemically identical to thyroxine produced by the thyroid gland. Must be obtained from Health First Family Pharmacy when possible and are This tier includes Specialty Drugs (SP) that Some plans may be limited to a 30 day supply. Details about your specific benefit for each tier are included in your Summary of Benefits. This tier includes brand name drugs and some This tier includes preferred brand name drugsĪnd some higher cost generic drugs. Details about your specific benefit for each tier are included in your Summary of Benefits. I was lost a total of 5 lbs but since I started taking the whole pill it seems that my weight is staying the same. I started out taking a half a pill for 8 days. This tier includes generic drugs. Details about your specific benefit for each tier are I am taking levothyroxine 88 mcg for 10 days. Includes preferred generic drugs. Details about your specific benefit for each tier are This is the lowest cost sharing tier that Thyroid Hormones - Synthetic T4 (Thyroxine)
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