2024 Essential Drug List 3-Tier
The 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.
Preventive
care drugs: We cover preventive care drugs with zero cost share in compliance
with the Affordable Care Act (ACA).
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.