(1) To ensure access to quality prescription drug coverage and contain pharmaceutical costs, a PRC enrollee must utilize cost-effective medications when medically appropriate. Only those medications listed in the PRC Formulary will qualify for the Samish mail-order pharmacy benefit.

(2) The PRC enrollee or an individual or agency acting on behalf of the eligible person, or the provider, must first register with the contracted mail-order pharmacy.

(3) The most current PRC Formulary can be found on the Samish members-only website. A printed copy may be requested through the PRC office.

(4) A PRC enrollee must use the contracted mail-order pharmacy for maintenance medications unless the primary insurance requires otherwise. PRC staff may offer assistance if extreme barriers are present to self-manage Samish mail-order benefits.

(5) New medications or medications that must be obtained urgently (antibiotics, for example) may be paid for by the PRC enrollee at their local pharmacy. It is imperative that the PRC enrollee mention Indian Health Services, Samish Indian Nation. Instructions for reimbursement requests may be obtained through the PRC office.

(6) The procedure to make an anonymous request for consideration of adding a medication to the formulary is on the Samish members-only website. The request will be evaluated at a regularly scheduled meeting by the HHS Director, Health Director, Diabetes Program Manager/Public Health Nurse, Health Services Specialists, and our contracted pharmacist(s). [Res. 2020-10-013 § 2, 2020.]