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Managing Your Pharmacy Benefit

Our goal is to help get the safest, most effective and most valuable medications in your hands when you need them. To help us manage your pharmacy benefit, we’ve put several programs in place that focus on safety, effectiveness and value.

The foundation for all of our work is our medication review process. We go beyond the FDA to evaluate the safety, effectiveness and value of medications prior to making drug recommendations for our plans. Drugs that are found to be the safest, most effective and most valuable in their class are added to the formulary for your plan. The Formulary is a list of prescription generic, brand-name and specialty drugs that have been approved by the FDA and are covered under your plan. Please visit our Formulary page for information about our formularies as well as recent and upcoming updates to our formularies.

We have made some changes to our list of covered medications (formulary) for 2017. The new formulary offers greater flexibility for consumers to choose lower cost, comparable alternatives to high-cost brand and generic drugs. We encourage you to review the 2017 list to see if any medications you might be taking have changed status

We also offer a Preventive Medications list, which contains drugs used to prevent a disease or condition for people who have risk factors for that disease or condition. Preventive medications can also be used to prevent a disease or condition from reoccurring in people who have already recovered. Under some plans, you may not need to pay a copay or coinsurance, or meet your deductible for preventive drugs to be covered. 

Using your medications correctly helps your drugs have the best chance of being effective for treating your condition. We aim to improve the quality of your drug therapy by promoting the appropriate use of medications and helping you make decisions about your care and prescription drugs. Please visit our  Prior Authorization page for information about which drugs require prior authorization or have Qualtity Limits in place. To help you stay on track with your medications, we’ve created Medication Policies, which contain Step Therapy information and act as guardrails to guide you to take the right medications at the right times and are available for all medications in the prior authorization program.

 

Making Your Pharmacy Benefit Work for You

We want to help you get the most from your benefits by giving you access to the information you need to make smart decisions about prescription drugs. Here are some resources:

  • With the Rx Price Guide, you and your doctor can access up-to-date information on the price of prescription drugs.
  • To identify the most cost-effective alternative drugs, and learn about therapeutic interchange, check out the Generic Alternatives page.
  • In a pinch and need a medicine that requires pre-authorization now? Read the Emergency Medication Fill policy to find out how to get the medicine you need while your pre-authorization is processed.
  • Learning about medications can be confusing. We have created Consumer Rx documents to provide descriptions and answers about your prescription drugs. 
  • Have multiple prescriptions? Our Prescription Synchronization policy can provide added convenience by allowing you to refill your ongoing prescriptions at the same time.
  • Looking to save money? Our Half Tablet Savings, Free Glucose Monitor and Special programs are additional resources to help maximize your pharmacy benefit.

 

Member Resources

Do you need to find a Participating Pharmacy?  Do you want to have your refilled prescription drugs Mailed to you? Do you need to order a Specialty Medication?  Do you need to request Prior Authorization for a drug on the Formulary, or request an Exception to cover a drug not on the Formulary because no Formulary drugs will work? If so, we have the resources you need. Simply select the link from the list to the right.

Have questions? Give us a call at the number on your member ID card and we’ll be happy to help you.

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