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How to Find Out if a Drug is Covered
Our instructional video will help you learn how to use our formulary (drug list) to find out if a drug is covered, what tier it’s on, and any special requirements.
When you are prescribed a new drug, it’s a good idea to look it up in the formulary to make sure it’s covered, find out what tier it’s on, and see if your drug has any special requirements. The formulary (drug list) lists all the drugs we cover alphabetically and by medical condition so they’re easy to find.
If your drug is not listed on the formulary, you may be able to get a temporary supply in certain circumstances. This gives you time to talk to your doctor and see if another prescription would meet your needs. Temporary supplies for new members are generally a 30-day supply, and available one time only during the first 90 days of your membership.
Every drug in the formulary (drug list) has a tier number. You’ll find the tier number listed next to each drug. The tier number determines the general cost of the drug. In general, the lower the tier, the lower your cost for the drug. Plus, if the retail amount for a drug is lower than your copayment, you pay the lower amount.
A generic drug has the same active-ingredient formula as a brand name drug and can help save you money on prescription drug costs. Generic drugs are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs. If you take a brand name drug, ask your doctor if there is a generic version that is right for you.
Please note, prescription drug information may be different if you receive your benefits from a current or former employer.
Some drugs have special requirements. The formulary (drug list) will tell you if a drug has special requirements, such as:
If your drug has a special requirement, you or your doctor may need to take extra steps in order for your drug to be covered. Call Customer Relations or check your Evidence of Coverage (EOC) for details on what you can do to get coverage for the drug. You can also ask us to remove a special requirement by requesting an “exception”. Your EOC includes information on how to request an exception. We are not able to remove special requirements in all cases, but each exception request is reviewed to see if removing the restriction is possible.