Providers are discouraged from providing non-formulary samples; however, if samples are given to the member, the entire course of therapy must be covered by the samples. Non-formulary medications provided as samples do not establish a continuity precedent; and, therefore, do not obligate coverage by KHS.

Requests for non-formulary medications or supplies may be submitted on the State of California Treatment Authorization Request (TAR) form, KHS referral form, or in letter format. Please include the patient identification number, medication failures and non-formulary item requested as well as information on the patient. The State of California form works well as there are specific fields for the necessary information. Fax the information to Kern Health Systems at (661) 664-5191. You may telephone Kern Health Systems about non-formulary requests but policy does require faxed or mailed information to be submitted.

The Pharmacy and Therapeutics Committee is composed of Physician and Pharmacist community providers as well as staff from Kern Health Systems. We have primary care providers, a specialty physician, community pharmacists (both chain and independent). Meetings are usually held quarterly. Issues you feel could improve our formularies or systems can be forwarded to the Corporate Pharmacist at the plan offices, 9700 Stockdale Highway, Bakersfield, CA, 93311, phone (661) 664-5101, fax (661) 664-5191. Input from providers is welcomed. If you would like to serve on the Pharmacy & Therapeutics Committee please advise our Corporate Pharmacist or Medical Director.

Barring any medically adverse responses from the member, the trial period of a medication shall be determined per the recommended dosing titration guidelines presented to the FDA.

During weekends, holidays and non-business hours a pharmacy may choose to dispense enough medication (72 hours supply maximum) as an emergency supply to the member until the next working day, at the dispensing pharmacist's discretion according to pharmacy policy and procedures. If the medication is not on the Plan Formulary, a request must be submitted for payment processing stating the emergency and medication dispensed. TAR approval is not needed for reimbursement before dispensing of 72 hour emergency supply of non-formulary drugs.

If a medication is available as an AB rated generic, then the brand name version will become non-Formulary. If a generic brand becomes available during a patient's treatment, the patient will be expected to switch to the generic brand and must fail the generic brand prior to KHS granting authorization for the brand name. Providers with patients having untoward effects from a generic brand will be required to submit a completed FDA MedWatch form to KHS as part of the authorization for a request to allow a brand name version instead of a generic brand.

For Kern Family Health Care (KHS Medi-Cal) most of the straight antipsychotic agents are carved out to Medi-Cal. Please see Appendix. For The Healthy Families Program patients these agents are covered though some may require prior authorization - again see appendix.