Complete Drug List 4-Tier with Split Generic Tier
by medication name for up-to-date drug information, including the benefit tier
your drugs are on, as well as applicable clinical edits such as prior
authorization or step therapy requirements.
Your coverage has
limitations and exclusions, which means that some drugs on this list may not be
covered, depending on your plan’s design. To find out more, please refer to
your Certificate/Evidence of Coverageor yourSummary Plan
Preventive care drugs:
We cover preventive care drugs with zero cost share in compliance with the
Affordable Care Act (ACA). We cover contraceptives for members enrolled in a
California plan according to state regulations.
Member cost share
amounts for certain abuse-deterrent opioid analgesics may be lower in the state
Maine due to state laws. For additional information, please call the Pharmacy
Member Services number on your ID card.
plans include our home delivery program at no extra cost to you. Find out more by calling the
Pharmacy Member Services number on the back of your ID card or by logging into
your secure member portal
To our providers: Our electronic prior authorization (ePA) process is the preferred method
for submitting pharmacy prior authorization requests. Creating an account
is free, easy and helps patients get their medications sooner. You can
complete the process through your current electronic health record/electronic
medical record (EHR/EMR) system or by using one of these ePA sites:
Log in to Surescripts®
Log in to CoverMyMeds®
This drug search tool will be updated at least quarterly.