Pharmacy Programs

These programs help our members pay less out-of-pocket on prescription drugs. They save money while continuing to receive the effective, high-quality medical care they count on.

Preferred Therapy

This program encourages the use of the most cost effective drugs over the higher priced brand-name medications if a prescription for the targeted brand-name medication has not been filled in the last six months (180 days).

Download the Preferred Therapy Drug List (PDF)

Generic Copayment Holiday

This program offers a copay waiver for three retail or three mail order prescriptions when members switch to the generic equivalent of a specifically targeted drug.

Download a list of drugs included in the Generic Copay Holiday Program (PDF)

Off-Label / High-Cost Specialty Review Program

This program disallows coverage for drugs prescribed for uses other than those approved by the FDA and requires a prior authorization review of other high cost specialty drugs.

Download the Off-Label / High-Cost Specialty Review Drug List (PDF)

Dose Optimization

We'll encourage the use of specific prescription drugs in once-daily dosage regimens, as opposed to using lower multiple doses of the same drug.

Download a list of drugs included in the Dose Optimization Program (PDF)

Brand-to-Generic Interchange

This program calls for single-source brand-name drugs to be interchanged with less costly generic alternatives. Though some targeted medicines do not have a generic equivalent of their own, similar prescription drugs with a generic counterpart are available, thus creating the interchange.

Download a list of drugs included in the Brand-to-Alternate Generic Interchange Program (PDF)

Quantity Limit for Selected Drugs

We'll block the dispensing of targeted drugs in quantities that are inconsistent with their labeling.

Generic Copay Waiver Program

We'll waive the first copay for a preferred generic drug when a member switches to the generic from the brand-name medication. 

Download a sample list of drugs included in the Generic Copay Waiver Program (PDF)

Questions? We can help!

To verify a member's benefit plan or get answers to your pharmacy-related questions, please contact us.

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