Drug Lists 2019
Preferred Drug List
Most of our plans use the Preferred Drug List (PDL). A PDL is a list of prescription drugs that an independent panel of doctors and pharmacists has chosen because they work well to treat your condition. They are also cost effective. Drugs on the PDL will cost you less out of pocket than those not on the list. You and your doctor, however, have the freedom to choose the medication that works best for you.
Try Generics Drug List
A few groups use the Try Generics Drug List. The Try Generics Drug List requires you to try a generic before your plan covers brand-name drugs that treat 12 common health conditions. Not sure if this drug list applies to your benefit plan? Log into My Health Toolkit® for personal information about your prescription drug coverage.
Specialty Drug List
Specialty drugs are prescription medications that are used to treat complex or chronic medical conditions like cancer, rheumatoid arthritis, multiple sclerosis and hepatitis, just to name a few. Depending on your plan, you may pay a different copayment or coinsurance for drugs on the Specialty Drug List.
Excluded Drug List
This is a list of drugs that are excluded from coverage, as well as how to request a formulary exception for an excluded drug.
$0 Covered Drug List
Under Health Care Reform, the Affordable Care Act (ACA) requires most health plans to cover certain drugs at $0 cost to members. View the $0 Covered Drug List.
Drug Management Programs
Not all members have all of these programs. Please check your Schedule of Benefits to find out which ones apply to you. Or use the Cost and Coverage Tool to look up a specific drug. This tool will tell you which, if any, drug management programs apply. The tool will also tell you whether the drug is on our Preferred Drug List.
Most of our members need prior authorization for certain drugs. Learn how the Prior Authorization Program works and which drugs are included in the program.
This program limits the amount of certain drugs your plan will cover. Learn how the Quantity Management Program works and which drugs are included in the program.
This program makes sure members get quality, cost-effective drug therapy. It groups drugs into two categories. Members must try one or more Step One Drugs before their plans will cover Step Two Drugs. Learn how the Step Therapy Program works and which drugs are included in the program.
Opioid Management Program
The Opioid Management program applies to all members and consists of daily quantity limits specific to each covered opioid drug and prior authorization requirements for certain prescribing situations. Learn how the Opioid Management Program works and which drugs are included in the program.