What is a Drug Formulary?
Drug Formulary is a list of drugs covered under your health plan.
What are the benefits of Drug Formulary?
There are many prescription drugs available in the market. Many of these drugs contain the same active ingredient(s) and are chemically identical in strength, concentration, dosage form, and route of administration with the drug prescribed by your physician. However, they differ significantly in their prices.
Drug Formulary management assures use of recommended drugs for appropriate and safe drug therapy methods in your interest. It also allows you to purchase a cost-effective alternative for the prescribed drug category that will eventually reduce your overall claim cost.
Who is responsible for the Drug Formulary of my Basic Plan?
Drug Formulary for Basic Plan is developed by the Health Authority of Abu Dhabi (HAAD) Pharmacy & Therapeutics Committee. The Committee consists of physicians, pharmacists and other health care professionals to decide on the list of drugs to be covered in the formulary for the Basic Plan.
To help members have the best possible health services, HAAD may add or delete drugs from the formulary or change coverage rules on some drugs. The details of your latest Drug Formulary are available at www.damanhealth.ae or alternatively you can also check them at www.haad.ae.
Which drugs are not covered under my Basic Plan?
• Drugs not listed in your Drug Formulary
• Drugs used to treat medical conditions not covered under your health plan
• Drugs used for cosmetic purposes
• Drugs used for non-medically necessary reasons
• Drugs used for experimental, investigational or unproven services and treatments.
• Drug prescription dispensed by a non network pharmacy.
Some drugs on the Drug Formulary may require additional checks to be performed by a pharmacist before the drug is dispensed, such as:
• Pre-authorization or prior approvals
• Consistency with age
• Limit on medication dispensed as per the physician’s prescription
• Annual Benefit Limit of AED 1,500 for your pharmacy benefit
What can I do if my prescribed drug cannot be found in my network or in my Drug Formulary?
For cases where a drug cannot be found within your Network Provider or does not exist in your Drug Formulary, you have the option to request exceptional consideration for coverage. If your request is declined, you may further approach us through our appeal process. Daman will discuss the merits of your case internally and externally and will communicate the decision to you within 30 calendar days from the date of appeal. Details of appeals process and the Appeals/Exception Request Form are available on our website www.damanhealth.ae
Whom can I contact in case of any queries?
You can call us at our toll free number: 800-432626. Our Customer Service representatives are available 24X7 to help you with any clarifications or queries.