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Our pharmacy committee decides exclude some drugs because other safe, effective, less costly alternatives are available. The list is current as of April 2022.
These prescription drugs, normally tier 4, are usually used to treat complex or chronic medical conditions. This list is current as of April 2022.
Under the health reform law (Affordable Care Act), benefit plans must cover certain Preventive Care Medications at 100% - without charging a copay, coinsurance or deductible.
This program limits the amount of medication prescribed at one time for certain covered prescriptions. The list is current as of April 2022.
These prescription drugs require your doctor to get approval before the plan will cover the cost of the medication. This list is current as of April 2022.
Prior authorization may be required through our Specialty Medical Benefit Management program. This list is current as of April 2022.
The drugs on this list must be filled under the pharmacy benefit and are not covered under the medical benefit. This list is current as of April 2022.
Step therapy has you try cost-effective "first-choice" medications before trying more expensive "second-choice" drugs. This list is current as of April 2022.