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Preferred & Preventive Drugs

In recent years, drug costs have increased dramatically. The rise in prices for medications can be a source of frustration for your patients. At the same time, we understand that harshly limiting the medications our physicians can prescribe in order to cut costs would only lead to frustration for our providers.

With such concerns in mind, our employer groups, physicians and members challenged us to develop a prescription benefit that helps reduce drug benefit costs while maintaining physicians' freedom to select the most appropriate drugs. We rose to the challenge by introducing our innovative Four-Tier Preferred Drug prescription benefit with the following copay structure:

  • Generic drugs at the lowest copay
  • Preferred brand name drugs at a mid-level copay
  • Non-preferred brand name drugs at a higher brand copay
  • Multi-Source brand name drugs at the highest copay

Preferred Drug Lists

Within this system, preferred drugs are brand-name medications that are periodically reviewed and updated by the Pharmacy and Therapeutics Working Group in order to ensure the highest level of clinical efficacy and cost effectiveness. We still provide coverage for non-preferred brand-name, multi-source brand-name, and specialty medications—only at a higher copay. The result is a prescription benefit program that will give you the freedom to choose the best, most cost-effective course of treatment for your patients.

If you have administrative questions about our preferred drug protocols, please contact the Provider Relations Department at 419-887-2535 or 800-891-2542.

Take a look at our current Preferred Drug Lists:

2018 Commercial Open Preferred Drug List (effective Jan. 1, 2018) 
2019 Commercial Open Preferred Drug List (effective Jan. 1, 2019) 

2018 Commercial Select Drug List (effective Jan. 1, 2018)  
2019 Commercial Select Drug List (eff. Jan. 1, 2019)

2018 Commercial Advanced Select Drug List (effective Jan. 1, 2018) 
2019 Commercial Advanced Select Drug List (eff. Jan. 1, 2019) 

2018 ACA/Alliance Drug List (effective Jan. 1, 2018) 
2019 ACA/Alliance Drug List (effective Jan. 1, 2019)

2018 Health Insurance Marketplace Drug List (effective Jan. 1, 2018)  
2019 Health Insurance Marketplace Drug List (effective Jan. 1, 2019)

Paramount Advantage (Medicaid) Preferred Drug List 

Preventive Drug Lists

Additionally, 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.

Take a look at our current Preventive Drug Lists:

2018 ACA Mandated Preventive Drug List

2018 CDHP Preventive List (effective Jan. 1, 2018)  
2019 CDHP Preventive List (eff. Jan. 1, 2019)