Prescription Benefits
Most of our employer group members have drug coverage as part of your insurance with us. Please be sure to look at your Paramount ID card to determine if you are covered for prescriptions. Or check with your employer.
Commercial Prescription Benefits
Find a Pharmacy
You can search for a local pharmacy here. Or visit MyParamount.org to sign into your personal account and view CVS Caremark plan information. For Specialty Drug pharmacies, please use this location directory.
More about your prescription benefits
We work with CVS Caremark to administer your drug benefit. While each Paramount plan may have different copays, there are a few features that are true for all plans.
Drug Formularies
Please look at your Summary of Benefits and Coverage (SBC) to determine which formulary to use. Or, view your benefits in MyParamount.org.
- ACA / Alliance Formulary
- Advanced Control Specialty Formulary
- Advanced Select
- Core
- Maintenance Choice
- Marketplace Formulary - 4 Tier
- Marketplace Formulary - 6 Tier
- Select
- Standard with Advanced Control Specialty (formerly called Commercial Open)
Prior Authorizations
A prior authorization requirement for your medication means that your doctor needs to request approval for coverage. Prior authorizations are common for all insurance companies. Medications that we target for prior authorizations are usually new, costly, or potentially toxic medications that may be replaced by less expensive, safer alternatives.
While your doctor will normally submit the request for a PA, you can view your drug formulary to identify which drugs require a PA. Once approved, you do not need to get approval each time the medication is filled. Prior authorizations are approved for a specific timeframe depending on the medication. Once the approved prior authorization timeframe has expired, then your doctor will need to submit a new prior authorization request.
Step Therapy
Step Therapy encourages providers to prescribe the most valuable and evidence-based treatments for you when you are beginning drug therapy for a medical condition. In most instances, it is not prudent to begin treatment with a brand-new, costly medication when there are options that are well-proven to be safe without the high price of a new product. Step Therapy policies require that a more cost-effective but proven and recommended Step 1 medication be tried before a Step 2 drug and a Step 2 drug before a Step 3 drug. You can view your drug formulary to identify which drugs require Step Therapy.
Preventive Drug
Some plans include coverage of preventive drugs that are not subject to deductibles, copays, or both. Please refer to your Summary of Benefits and Coverage (SBC) to determine if these lists apply to your plan, and how these drugs may be covered.
- ACA Mandated Preventive Drug List
- CDHP Value Added Preventive List (Select & Advanced Select formularies)
- CDHP Value Added Preventive List (Standard formulary)
- ProMedica Employee Health Plan HSA Preventive List
Specialty Drug Program
Our Specialty Drug Program provides the medication used to treat chronic conditions such as multiple sclerosis, cancer, hepatitis and rheumatoid arthritis. Although these drugs are self-administered, they are complex and often require special handling and monitoring. All specialty drugs are identified in your formulary.
Drugs available under the Specialty Drug Program must be obtained from a pharmacy in our Specialty Pharmacy Network.