Formulary

WHAT IS A FORMULARY?

The Member Formulary is a useful aid to understanding your drug benefit program. The formulary is a list of drugs reviewed and approved by an independent committee of physicians and pharmacists. The formulary includes drugs that are commonly prescribed by physicians, clinically useful, and cost-effective.

For a copy of your formulary, visit your HealthView portal.

Bring the Member Formulary to your doctor appointments. Your doctor can review the formulary and determine if a drug listed is appropriate for you. When you have a prescription filled, your co-payment will be at one of three levels or "tiers." Tier 1 and tier 2 drugs will be the lower co-payments. However, a tier 1 or tier 2 drug may not always be available or the best choice for your medical condition.

Tier 1

(lowest co-payment)

Includes only generic versions of brand-name drugs.*

Tier 2

(intermediate co-payment)

Includes selected brand-name drugs.

Tier 3

(highest co-payment)

Includes all brand-name drugs not listed in tier 2 and includes all brands not listed in this formulary.

*All generic drugs, whether listed in this formulary or not, are the lowest co-payment.

Generic versions of brand-name drugs are always in tier 1 (lowest co-payment.)

LEARNING MORE ABOUT GENERIC DRUGS

One way to reduce your out-of-pocket cost is by requesting a generic drug. A generic drug is a
copy of the original brand-name drug, whether prescription or over-the-counter. Generic drugs are usually
priced lower than their brand-name equivalents.

Generic drugs are:

  • Approved by the U.S. Food and Drug Administration for safety and effectiveness, and are manufactured
    under the same strict standards which apply to brand-name drugs.
  • Tested in humans to assure the generic is absorbed in the bloodstream in a similar manner as the brand-name
    drug. Generics may be different from the brand in size, color, and inactive ingredients, but this does not
    alter the effectiveness or the ability to be absorbed just like the brand-name drug.
  • Manufactured in the same strength and dosage form as the brand-name drug. When a generic drug is substituted
    for a brand-name drug, you can expect the generic to produce the same clinical effect and safety profile as the
    brand-name drug.

Make sure to:

  • Consult your pharmacist when you have questions about prescriptions and over-the-counter drugs.
  • Read and heed labels.
  • Take your medication exactly as prescribed.
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