The Drug List/Formulary is a list of FDA-approved brand-name and generic medications that have been reviewed and recommended for their quality and effectiveness by our National Pharmacy and Therapeutics (P&T) Committee. Our P&T Committee is an independent group of practicing doctors, and pharmacists, and other health care professionals responsible for the research and decisions surrounding our drug list. This group meets regularly to review new and existing drugs and choose the top medications for our drug list-based on their safety, effectiveness and value. Because the medications on the drug list/formulary are subject to periodic review, please ask your physician about the most current drug list additions and deletions or search medications here
Brand-name: A brand-name drug is usually available from only one manufacturer and may have patent protection.
Generic: A generic drug is required by the FDA to have the same active ingredients as its brand-name counterpart, but is normally only available after the patent protection expires on a brand-name drug. Although it may look different, a generic drug works the same as its brand-name counterpart. You can save money by using generic medications.
What are "clinically equivalent" medications? How does this affect my drug coverage?
The P&T Committee reviews the most current research available to determine if multiple drugs used to treat a disease/condition produce the same clinical effect. When this is the case, the committee may recommend that we cover only the lower cost drug(s) as part of our effort to help reduce the overall cost of care. This means your specific prescription plan may not cover some drugs (indicated by a ^ symbol next to the drug name) in classes with ‘clinically equivalent" alternatives.
What if my medication is not on the drug list/formulary? An open drug list allows members and their physicians to choose from a wide variety of prescription medications. Please talk with your doctor about prescribing a medication that is on the drug list/formulary. If a medication is selected that is not on the drug list/formulary, you will be responsible for the applicable non-formulary co-payment. You or your physician may submit a request to add a drug to the drug list/formulary either in writing or on our web site. Requests are taken into consideration by the P&T Committee during the drug list/formulary review process. Inclusion of a medication on the drug list/formulary is not a guarantee of coverage. Some drugs, such as those used for cosmetic purposes, may be excluded from your benefits. Please refer to your Certificate or Evidence of Coverage for coverage limitations and exclusions.