Advanced Drug List 5-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.
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
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.
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.
Most 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.