Rolling Hills Formulary
Rolling Hills Clinic mandates the use of generic products whenever possible in accordance with applicable law or regulations. Dispensing a brand name product when a generic is available requires a prior authorization.
Please click on the link below to open the accompanying formulary document.
Program Dispensing Policies
1. Rolling Hills Clinic mandates the use of generic products whenever possible in accordance with applicable law or regulations
2. Drugs marked with “^” require a prior authorization; Rolling Hills Clinic will request additional information before considering the authorization.
3. All drugs are to be dispensed with a maximum 30 – day supply; exceptions noted with “u” can be dispensed at 90 days’ supply
4. Drugs marked with “●“ must be dispensed with a minimum of 28 days
5. DEA class II and III drugs are to be dispensed with a maximum of 30 day supply
6. All control prescriptions (CIII – CV) must be reauthorized by the prescriber every 6 months. The claims adjudication system will accept 5 as the maximum number of refills. For non-controls, an annual max of 13 fills per prescription exists
7. Refills may be obtained after 80% of the previously dispensed days’ supply has been used; however, there is an annual maximum of 390 days fill per drug
Rolling Hills Clinic – Formulary (222 KB)