Find My Prescriptions

We pay for all medically necessary, Centers for Medicare & Medicaid Services (CMS) participating, FDA-approved products on the Preferred Drug List (PDL). These are drugs we prefer your provider prescribe. If there are any changes to the PDL, we will post them.

Step Therapy

You may need to try one or more drugs on the PDL before taking one that is not on the PDL. This is called Step Therapy. Some drugs are only covered if Step Therapy is used.

Generic Substitution

A pharmacy may give you a generic drug in place of a brand-name drug. This is called a generic substitution. Generic drugs have the same effect and safety as brand-name drugs. Your provider will need approval from us if they ask for a brand-name drug when there is a generic drug available. This is unless the brand is noted as preferred.

Therapeutic Interchange

Sometimes you cannot take a certain drug, like if you have an allergy. Other times, a drug might not work for you. In these cases, your provider can ask us to cover a drug that is not on the PDL.

Exceptions

You may ask us to cover a drug not on the PDL. You may ask for an exception because of an allergy, not being able to take a drug, or a poor response to the PDL drug. We will work with your provider to get what we need after we get your request.

Member Services: 1-833-230-2005 (TDD/TTY: 711) Monday through Friday, 8 a.m. – 5 p.m. CT