Prescription drug benefits

Formulary (covered drug list)

Formulary updates

PPACA preventive services

Some preventive medications may be covered at no cost to you when filled at a participating pharmacy with a valid prescription.

January updates

Formulary requirements/ 
Guide to prescription drug benefits

Here you’ll find lists of drugs that have special requirements before they are covered by your plan, and an overview of how to use your prescription drug benefits

QHDHP preventive drugs

(This option is available to large groups of 100+ employees and is standard for all groups of less than 100 employees.)

Check your Certificate of Coverage to see if this option applies to your QHDHP. If so, some preventive and maintenance medications will have the deductible waived, and you will be charged only a copay.

Value-Based Design drug list

The prescription drug Value-Based Benefits program is designed to increase adherence to medications used to treat angina/arrhythmia, asthma, diabetes, diabetic supplies, high blood pressure/other cardiovascular conditions, and high cholesterol, which are available to you at a reduced cost. When taken regularly and as prescribed, medications to treat these conditions can increase your likelihood for healthier outcomes.

Limited distribution specialty drugs

This drug list includes drugs on our Commercial formulary. Limited distribution (LD) meaning there is a restriction on which pharmacies can dispense them. This limits where the member may obtain the prescription. Members may be required to use another pharmacy for limited distribution prescription drugs.

Additional offerings

The oral chemotherapy medication list includes drugs on our Commercial formulary.

Refer to the Value, Value Plus, Elite or Exclusive formularies for the medications included with those plans.