Physicians Health Plan of South Michigan will be transitioning its membership to Priority Health, subject to regulatory approval.

Physicians Health Plan of South Michigan Named One of the Best in The Nation by U.S.News & World Report/NCQA “America’s Best Health Plans” 2006

For the second year in a row, Physicians Health Plan of South Michigan has been named one of the best commercial health plans in the nation by the U.S.News & World Report/NCQA "America's Best Health Plan"* 2006.

iSave

PHPSM is proud to offer you iSave - our six new high deductible health plans (HDHP's). iSave features low premiums and first dollar coverage for preventive care. iSave helps you get your healthcare spending back on track. For more information, please click the title link above.

Leapfrog

Leapfrog is a program to provide information about health care safety, quality and customer value. Click the title above for more details.

Physicians Health Plan of South Michigan's Physicians Area

Glossary of Common Terms

Brand Name
A Prescription Drug Product: (1) which is manufactured and marketed under a trademark or name by a specific drug manufacturer; or (2) that we identify as a Brand-name product. We classify a Prescription Drug Product as a Brand-name based on available data resources, such as First DataBank, that classify drugs as either brand or generic based on a number of factors. You should know that all products identified as a “brand name” by the manufacturer, pharmacy, or your Physician may not be classified as Brand-name by us.

Generic
A Prescription Drug Product: (1) that is chemically equivalent to a Brand-name drug; or (2) that we identify as a Generic product. Classification of a Prescription Drug Product as a Generic is determined by us and not by the manufacturer or pharmacy. We classify a Prescription Drug Product as a Generic based on available data resources, such as First DataBank, that classify drugs as either brand or generic based on a number of factors. You should know that all products identified as a “generic” by the manufacturer, pharmacy or your Physician may not be classified as a Generic by us.

Network Pharmacy
A pharmacy that has:

Entered into an agreement with us or our designee to provide Prescription Drug Products to Covered Persons
Agreed to accept specified reimbursement rates for dispensing Prescription Drug Products
Been designated by us as a Network Pharmacy

A Network Pharmacy can be either a retail or a mail service pharmacy.

New Prescription Drug Product
A Prescription Drug Product or new dosage form of a previously approved Prescription Drug Product, for the period of time starting on the date the Prescription Drug Product or the new dosage form is approved by the FDA, and ending on the earlier of the following dates:

The date it is approved by our Preferred Drug List Management Committee
December 31st of the following calendar year

Preferred Drug List
A list that identifies those Prescription Drug Products which are preferred by us for dispensing to Covered Persons when appropriate. This list is subject to our periodic (at least quarterly) review and modification. Contact us at the telephone number on your ID card to obtain a copy of the current Preferred Drug List or you can access it through the Internet at 365 Well Street.

Prescription Drug Cost
The rate we have agreed to pay our Network Pharmacies, including a dispensing fee and any sales tax, for a Prescription Drug Product dispensed at a Network Pharmacy.

Prescription Drug Product
A medication, product or devise that has been approved by the Food and Drug Administration and that can, under federal or state law, be dispensed only pursuant to a Prescription Order or Refill. A Prescription Drug Product includes a medication that, due to its characteristics, is appropriate for self-administration or administration by a non-skilled caregiver. For the purpose of Benefits under the Policy, this definition includes:

Inhalers (with spacers)
Insulin
The following diabetic supplies

Insulin syringes with needles;
Blood testing strips-glucose;
Urine testing strips-glucose;
Ketone testing strips and tablets;
Lancets and lancet devices;
Insulin pump supplies, including infusion sets, reservoirs, glass cartridges, and insertion sets;
Control solutions and combo kits;
Glucose monitors

Prescription Order or Refill
The directive to dispense a Prescription Drug Product issued by a duly licensed health care provider whose scope of practice permits issuing such a directive.

Usual and Customary Charge
The usual fee that a pharmacy charges individuals for a Prescription Drug Product without reference to reimbursement to the pharmacy by third parties.