Hint: Your Outline of Coverage lists YOUR specific prescription drug information.
| your Rx Plan | cost-saving strategy |
|---|---|
| Three-Tier Prescription Drug Program |
Tier 1 - Generic Drugs - LOWEST cost-sharing Tier 2 - Preferred Brand-Name Drugs - MIDDLE cost-sharing Tier 3 - Brand Name Drugs NOT on our Preferred Brand-Name Drug List or, brand name drugs WITH a generic alternative - HIGHEST cost-sharing |
| HSA-Compatible Health Plans |
|
| Prescription Drug Benefits Program |
|
| Program | Description | Reference |
|---|---|---|
| Prior Approval | We require your provider to request Prior Approval for certain medications. | Prior Approval List |
| Quantity Limits | Your provider may need to provide documentation if a prescription amount exceeds our criteria. | Quantity Limits List |
| Step Therapy |
Providers should always try less expensive drugs before using the newest, most expensive drugs. | Step Therapy List |
Quick LinksGeneric Drug Equivalents
Preferred Brand Name Drug List Prior Approval Drug List Quantity Limits Prior Approval Drug List
Step Therapy Prior Approval Drug List
Eligible Over the Counter Medications

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