Prescription Drug Coverage in Assisted Living and Long-term Care Facilities

October 2021

Neighborhood wants to ensure our members residing in assisted living and long-term care facilities have access to safe and cost-effective treatment options.  It is the expectation of Neighborhood that our provider partners utilize Neighborhood drug formularies when creating drug treatment plans for our members.

If a Neighborhood member requires a drug that is not on their respective formulary, including a non-formulary over-the-counter (OTC) drug or a medication that has a restriction, providers must work with Neighborhood to obtain approval by submitting a Prior Authorization.

Similarly, dispensing pharmacies servicing members in assisted living and long-term care facilities may also request that you submit a Prior Authorization for drugs that have a utilization management (UM) restriction (including non-formulary and over-the-counter (OTC) drugs), prior to placing an override and dispensing the medication.