2023 Essential Drug List 5-Tier with Split Generic Tier
The Essential 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.