National Drug List 3-Tier
The National Drug List is a list of prescription medications approved by
the U.S. Food and Drug Administration (FDA). We’ve reviewed these drugs through
our Pharmacy and Therapeutics (P&T) Process, which considers a drug’s:
- Effectiveness
- Safety
- Similarity to other drugs within
a therapeutic class
- Affordability
PLEASE NOTE: Your coverage has
limitations and exclusions. This means that some drugs on this list may
not be covered, depending on your plan’s design. For example, your
plan might not cover certain drugs for cosmetic uses or to treat conditions
such as weight loss, infertility, or erectile dysfunction. To find out if your
drug is covered, log into your member portal or use the Sydney app to Price a Medication and refer to your plan documents.
Search
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.
Drugs with upcoming changes are noted when you select a drug from the search results list below. Look for this icon in the Notes & Restrictions section to verify if a drug has an upcoming change planned. A full list of upcoming changes to the drug list can also be found here. The drug list is reviewed and updated twice a year and changes typically go into effect starting on 1/1 and 7/1.
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, Colorado and Maine 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.
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.