Formulary ManagementThe drug list, also called a formulary, includes both brand and generic drugs. It will tell you whether any restrictions or limitations to coverage exist such as:
- Prior authorization
- Step therapy
- Quantity limits
- Adding or removing a drug from the drug list
- Moving a drug to higher or lower tier
- Adding or removing coverage restrictions
- Replacing a brand name drug with a generic
- Or if the U.S. Food and Drug Administration finds that a drug on the formulary is unsafe and the manufacturer removes it from the market, we will update our formulary accordingly.
Prior Authorization Criteria
A prior authorization may be required for certain prescription drugs.
Step Therapy Criteria
You may be required to try a certain drug to treat your medical condition before another drug is covered for that condition.
- Important Message About What You Pay for Vaccines – Our plan covers most Part D vaccines at no cost to you, even if you haven’t paid your deductible. Call Pharmacy Member Services for more information.
- Important Message About What You Pay for Insulin – You won’t pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it’s on, even if you haven’t paid your deductible