FORMULARY
EACH HEALTH PLAN INCLUDES A PRESCRIPTION DRUG FORMULARY, WHICH IS A LIST OF COVERED MEDICATIONS. THE FORMULARY IS DIVIDED INTO TIERS, AS SHOWN IN THE EXAMPLE BELOW. THE NUMBER OF TIERS MAY VARY BY PLAN AND THE COST FOR EACH 30-DAY SUPPLY OF A COVERED PRESCRIPTION DRUG DEPENDS ON THE TIER IN WHICH THE MEDICATION IS LISTED.
GENERIC DRUGS
Commonly prescribed generic drugs.
PREFERRED BRAND
Brand name drugs that do not have a generic equivalent.
NON-PREFERRED BRAND
Higher-priced brand-name drugs. Often have a generic equivalent.
SPECIALTY DRUGS
These drugs are used to treat complex conditions like cancer.
Your plan provides higher savings for prescriptions filled at in-network pharmacies. You will want to consider your network, along with your plan's drug tiers, to get the best value. You can also use Express Scripts® Pharmacy mail service for a 90-day supply of your maintenance medications.
You can save money by choosing a generic medication from your plan's prescription drug list.
DRUGS ADMINISTERED IN AN OUTPATIENT SETTING
Under some of our plans, benefits for certain prescription drugs and covered services administered in an outpatient setting are now available only under a prescription drug plan, not your medical plan. Examples of an outpatient setting include a home health care agency, physician's office, outpatient hospital or other outpatient facility. To find out if this applies under your plan, please contact our Member Services Department at the number shown on the back of your member ID card.
These drugs and covered services include some of the following: oral medication, intravenous solutions, biologicals and medicines. This provision does not affect drugs like allergy injections or pain medications you may receive in an outpatient setting. It only affects some high dollar drugs that should be purchased through a specialty or in-network pharmacy.
Benefits for the following drugs are only available if the drugs are purchased through a specialty or in-network pharmacy. Review the list of the prescription drugs and covered services for which benefits may be available.
IMPORTANT: This list may be updated at any time without notice. Please be aware that including a medication on this list does not ensure coverage.
SPECIALTY DRUG BENEFITS
Our Specialty Drug Benefit program provides a convenient, cost-effective way for you to order specialty medications for delivery directly to your home or physician's office. Specialty medications are typically self-administered injectable drugs used to treat serious or chronic medical conditions such as multiple sclerosis, hemophilia, hepatitis and rheumatoid arthritis. Our Specialty Pharmacy Program Drug List outlines the products designated as specialty medications.
How to Enroll
Complete this referral form or call 833-715-0973 to participate.
