How Do I Know if My Plan Covers My Prescription Drug?
When your doctor prescribes a drug you've never taken before, you may wonder if your plan will help pay for it. Or maybe you need to know what tier a drug is in, or whether it's a preferred or nonpreferred brand.
You have different options for getting this information. We'll help you understand where to look.
Use this option when you want to find out:
After you log in, look for the prescription section under My Coverage, then:
Tiers are used to define what your copay or coinsurance will be for a drug. It's best to get this information in your member account on our website. Go to My Coverage, then:
You'll find out how many tiers your plan has and what you pay for each tier.
Drugs approved by the U.S. Food and Drug Administration and covered by your insurance are listed in your plan's drug list, or formulary.
Each plan has a main drug list. Use it to find out:
You'll need to know the name of your plan and the name of the drug. It'll be easier to find a drug if you know what it's used for.
Most plans also have specialized drug lists just for:
These drugs are included on your plan's main drug list. But you'll get more information about them in the specialized lists.
If the drug is on the medical part of your benefit, talk to your doctor about getting preapproval for it.
If you have a PPO or HMO plan, and the requested drug is not on your approved drug list and you need your request taken care of right away, fill out our expedited request form.