Types of Prescription Drug Plans

A few things to keep in mind about our drug coverage:

Preferred Drug Lists: Some prescription drug plans have a preferred drug list (PDL) associated with them. The PDL is a list of drugs that are shown to have the highest clinical efficacy and are cost effective. They are typically low cost for your employees and save you money as the employer. 

• ACA / Alliance Formulary
• Commercial Advanced Select
• Commercial Core
• Commercial Select
• Maintenance Choice

• Standard with Advanced Control Specialty (formerly called Commercial Open)

Preventive Drug Lists: Some plans include coverage of preventive drugs that are not subject to deductibles, copays or both. Below are our current preventive drug lists: 

• ACA Mandated Preventive Drug List
• Value Added Preventive List (Select & Advanced Select formularies)
• Value Added Preventive List (Standard formulary)

Prior Authorizations: Some medications require a prior authorization before they can be dispensed. We work with the prescribing doctor to facilitate the prior authorization request. Usually, a prior authorization is required when the drug is new, costly or potentially toxic. 

Step Therapy: Certain drugs are subject to step therapy requirements. This requirement means we ask doctors to prescribe drugs that we know are safe and cost-effective first before they prescribe a new, more expensive medication. If your employee has already tried other medications, the doctor can send us documentation outlining what they have tried before. 

Specialty Drug Program: With so many advances in the healthcare field, new drugs are discovered all of the time. Often, these new medications are very expensive and complex. Our specialty drug program asks members to use select pharmacies to fill these medications.