Filling prescriptions

Here is some helpful information when your provider gives you a prescription.

• Check the Approved Drug List (also called a "formulary") for your plan to make sure the drug you need is listed and covered.
• You can get up to a 31-day supply of any drug on the formulary for one copay.
• You must order your prescription from an in-network pharmacy for it to be a covered benefit. Search for in-network pharmacies near you using our Find a Doctor tool. (Hint: You can log in to search for your personalized network for your plan.)

What you will pay for prescriptions

Your plan may have a deductible, which is the amount you pay first before the plan starts to pay. After you pay your deductible, you will pay a copayment or coinsurance for your prescriptions. The copayment or coinsurance will depend on your plan and the drug tier.

Some prescriptions are covered before you meet the deductible so check your plan documents or log in to your Priority Health member account to see your deductible balance (if any) and what you'll pay for your prescriptions. There's a tool to price medications.

Drug tiers

"Tiers" are simply a way of grouping prescription drugs by cost and purpose. Generic drugs are the least expensive because they're not brand names. It's the difference between buying Kleenex^® Tissue and other tissues; some are equivalent to brand-name products in the way they're made, and some treat the same conditions, but they cost less, so your copay may be lower.

Tier 1a	$	The least expensive prescription drugs available to you. Includes lowest-cost generic drugs–proven to be as safe as brand-name drugs–and, on some formularies, select brand-name drugs.
Tier 1b	$	Includes low-cost generic drugs–proven to be as safe as brand-name drugs–and, on some formularies, select brand-name drugs.
Tier 2	$$	Includes preferred and lower-cost brand-name drugs and some higher-cost generic drugs.
Tier 3	$$$	Non-preferred and expensive brand-name drugs, as well as higher-cost generic drugs. To save you costs, ask your provider if a tier 1 or 2 option can be prescribed instead.
Tier 4	$$$$	Includes very expensive brand-name and generic drugs, and preferred specialty drugs used to treat complex conditions.
Tier 5	$$$$$	Non-preferred specialty drugs and the most expensive brand-name and generic drugs. Most have a similar lower-cost option offering the same clinical value on tiers 1 through 4.

Asking for an exception

Our plan's Approved Drug List should have all the drugs you need for your health. But if your doctor thinks you need a drug that's not on our list, you can ask us to make an exception. Learn more about the process.