Coverage and cost
Get answers to common questions below.
Why did the cost of my medication change even though everything on my plan is the same?
There are different factors that may change the cost of your medication.
These changes may occur due to supply and demand, new generic drug availability, contract changes with the pharmacy, or what phase of the Part D benefit you are currently in.
What is a covered drug list/formulary?
This is a list of prescription generic, brand-name, and specialty drugs that have been approved by the U.S. Food and Drug Administration (FDA). If your drug is not on this list, it will not be covered. Drugs not on this list may be covered through the Formulary Exception Process. Visit our web site to get updated information on our Drug List.
In some cases, only certain dosages or formulations of a medication are covered. We encourage you to use our searchable formulary tool (“Find Medicines”), available on our web site) or call our Customer Service team for full coverage information.
Health plans use the covered drug list to provide you with safe and effective drug therapies at reasonable costs. It’s important to talk to your doctor about using a drug on your covered drug list when possible.
Please refer to your health plan policy for more information about the terms and conditions of your prescription drug benefit. If you have questions about any of your medications, please discuss them with your doctor or pharmacist.
How are drugs selected to be on the covered drug list/ formulary?
The covered drug list/formulary is developed and maintained by the Pharmacy and Therapeutics (P&T) committee. The P&T Committee is made up of pharmacists, physicians, and community members who meet regularly to review the safety and efficacy of drugs.
What is a network pharmacy and why should I use one?
A network pharmacy is a pharmacy that is contracted with the Plan to fill your Part D covered drugs. Using a network pharmacy ensures that your Part D benefits are applied correctly, and you are charged the appropriate cost-share. Medicare only allows use of an out of network pharmacy in an emergency situation. You will pay more for your drugs at an out of network pharmacy. You will be responsible for 100 percent of the cost of your prescription, and will have to submit your receipt for reimbursement. Your plan does not guarantee reimbursement for prescriptions filled at an out of network pharmacy.
Finding a pharmacy in the network is easy. Visit Find a pharmacy, where you have the option to search for network pharmacies by zip code or pharmacy name.
What can I do to help lower my prescription drug costs?
Consider switching to a generic drug, if one is available. Generic drugs are proven safe and effective by the Food and Drug Administration (FDA). A generic drug is the same as its brand-name drug counterpart in:
- Dosage
- Performance
- Quality
- Safety
- Strength
- Usage
To find out if a generic equivalent is available for your prescription drug, search by drug name under the Find Medicines link. Check your benefit plan for coverage. You can also talk to your pharmacist or your provider.
What is home delivery/mail order?
If you take maintenance medications for a chronic condition, you can eliminate trips to the pharmacy and have prescriptions shipped to the location of your choice through our mail order pharmacy. You can get 90 or 100-day supplies depending on your plan and automatic shipments sent to any address to ensure you don’t miss a dose even if you’re away from home. Some benefit plans may require you to get your long-term medications through one of our mail order pharmacies. Sign in to your account to see your options.
