Guided Drug List 4-Tier with Split Generic Tier
The Guided 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:
to other drugs within a therapeutic class
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.
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.
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.