Premium Formulary Drug Lists and Drug Management Programs
The information in this section applies to members whose health plans use the Premium Formulary instead of the Lowest Net Cost Formulary. Not sure if this applies to you? Check with your benefits coordinator.
Drug Lists
Want to know if a medication is covered? Check these lists to see what your plan covers and what coverage rules might apply.
Premium Formulary Drug List
The Premium Formulary list includes many of the drugs your plan covers. The list includes generic or preferred brands to treat many common conditions. You’ll save money when you use these drugs instead of non-preferred drugs. Doctors and pharmacists developed this list — and occasionally make updates to it — based on safety, efficacy and cost-effectiveness.
No-Cost Preventive Services List
The Affordable Care Act (ACA) requires most health plans to cover certain preventive services at no cost to members. View the No-Cost Preventive Services List.
Formulary Drug Removals List
You can review the Premium Formulary Excluded Drug List to see medications that are not covered.
Drug Management Programs
Some plans include drug management programs for certain medications. These may include:
Prior Authorization
You must get approval from the health plan before beginning some medications. Learn more about the Prior Authorization Program.
Quantity Management
You can only get a certain quantity of some drugs within a given time frame. There are some exceptions, with prior authorization. Learn more about the Quantity Management Program.
Step Therapy
Step therapy requires you to try more cost-effective options first. There are some exceptions, with prior authorization. Learn more about the Step Therapy Program.
Log into My Health Toolkit® to Review Your Pharmacy Benefits
To see what your specific plan covers, log into My Health Toolkit. Under Benefits, look for Prescription Drugs.
Drug Pricing Tool
Use this tool to estimate your prescription drug cost.