National Direct Drug List 5-Tier
The National Direct 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:
- Similarity
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.
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). We cover contraceptives for members enrolled in a California 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.