Alert Message: Visit our coronavirus resources page to get the latest information on COVID-19 and learn more about the new vaccines. Tier 1 or Tier I: Tier 1 drugs are usually limited to generic drug… This list may help guide you and your doctor in selecting an appropriate medication for you. h�b```f``��,B ���� Find 2020 drug name Important information There’s a lot more information on changes to our drug list (formulary), prior authorization, step therapy, quantity limits, exceptions and transition rules. The second column (labeled Drug Tier) will list what tier the drug is placed on in the Drug Formulary. 2020 Drug List ; Starting January 1, 2020, some changes were made to the prescription drug benefit. 20201 COMPLETE DRUG LIST (FORMULARY) Prescription drug list information UnitedHealthcare® Group Medicare Advantage (PPO) ... • Your drug’s tier. Can the Comprehensive Drug List … The drug list is regularly updated. The chart below shows the differences between the tiers. ���c�v}a��x�����VG��t�g0���b%XO��b"z�U���!�������ނ��*־F���b'YkK8f4��� ����A���Ɏ� �2b�X9��!��Zq0*��`7[���A���,��BbXcd�sf}���B��,��U�bAl⌳�;��ټ6�d 9�oA�1Y���������_�!���@m�| �s�O �Op(0�34H�x��@Ijhhh*A ���d����д�r(( ��QgŰ ���đm�����z%A\�#ۅ'$zz��%%�,776eef���'II���Jp*N@�p��Ĉ�bI�m=��$��Trb��n>�.S'�ӟ��p�[����ܷ��֦')w��a�[;R���T���l�ƌ (������Dt0��"���V�M��ġ*�K�4(�dKt40)��F�� 2020 4-Tier Drug Formulary PLEASE READ: THIS DOCUMENT HAS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN. Your drug’s tier. If you need help paying for your prescription or finding out what coverages you have, review Humana’s drug list to determine your prescription coverage eligibility. If … "�8%L�p� endstream endobj startxref Health Insurance Exchange 6 Tier Drug List January 2021 (Plan Year 2020) Please consider talking to your doctor about prescribing preferred medications, which may help reduce your out-of-pocket costs. Florida Medicaid Preferred Drug List, opens new window. Illinois. Each main plan type has more than one subtype. This drug list was updated in December 2020. This PDL applies to members of our UnitedHealthcare, Neighborhood Health Plan, River Valley, All Savers and … Key Terms Formulary A formulary is a list of prescription medications developed by a committee of practicing physicians and practicing pharmacists who represent a variety of specialty areas and who are … This Prescription Drug List (PDL) is accurate as of Jan. 1, 2020 and is subject to change after this date. If you need help or have any questions about your drug costs, please review your Evidence of Coverage or call Member Services. The numbers in the Tier column on the prescription drug formulary indicate the cost share for the medication. Introduction . If you have questions about a medication that is not on the comprehensive drug list, please call customer service at 800-340-1305, 24 hours a day, seven days a week. 2021 Cigna Individual & Family Plans Drug List. Tier 3 - Highest copayment covers higher cost brand name drugs. Tier 2 - Medium copayment covers brand name drugs that are generally more afordable, or may be preferred compared to other drugs to treat the same conditions. Also, when adding the new generic drug, we may decide to keep the brand-name drug on our Drug List… Your 2020 Prescription Drug List Advantage 3-Tier This Prescription Drug List (PDL) is accurate as of Jan. 1, 2020 and is subject to change after this date. Each covered drug is in 1 of 4 drug tiers. 4-Tier Prescription Drug List, January 2021. 508 0 obj <>/Filter/FlateDecode/ID[<4F70B847A091EE4E93719F42E72B536D>]/Index[497 24]/Info 496 0 R/Length 76/Prev 810590/Root 498 0 R/Size 521/Type/XRef/W[1 3 1]>>stream There is, however, a list of drugs that Tufts Health Plan currently does not cover. We update these documents each year. View the 2020 changes. endstream endobj 498 0 obj <> endobj 499 0 obj <> endobj 500 0 obj <>stream Learn more about how to read a drug list. Blue Cross and Blue Shield October 2020 Multi-Tier Basic Drug List I Introduction Blue Cross and Blue Shield is pleased to present the 2020 Drug List. 2020 AHCA Non-Formulary Alternatives List, PDF opens new window. There are thousands of drugs listed on the Tufts Health Plan covered drug list. The Prescription Drug List (PDL) is the list of covered medications for PHP Marketplace Members and Members who have coverage through their employer group. 1. There are three documents in the Formulary column. drug list updated 01/2021 - 5 for pdl007 drug name drug level utilization management requirements 1st tier unifine pentips 29 gauge x 1/2" needlemm 1 1st tier unifine pentips 31 gauge x 1/4" needlemm 1 1st tier unifine pentips 31 gauge x 3/16" needlemm 1 1st tier unifine pentips 31 gauge x 5/16" needlemm 1 1st tier … If you do not see the druglist you need, please visit Prescription Drug Lists and Coverage Select the drug form, strength and dosage. For Standard Option and Basic Option, you will generally pay the lowest cost share for any Tier 1 generic drug or Tier 4 Preferred specialty drug.   Call the phone number on your health plan ID card. Each tier has a copay or coinsurance ... • Drug list exception: Ask the plan to cover your drug even if it’s not on the drug list. We may immediately remove a brand-name drug on our Drug List if we are replacing it with a new generic drug that will appear on the same or lower cost-sharing tier and with the same or fewer restrictions. 2020 Formulary (List of Covered Drugs PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ... remove drugs on the Drug List during the year, move them to different cost-sharing tiers, ... • You can ask us to cover a formulary drug at a lower cost-sharing level if this drug is not on the specialty tier… Tier 2 Primarily non-preferred generic drugs that have a Tier 2 copay. Each covered drug is in 1 of 5 drug tiers. Use the Drug Coverage & Pricing Tool Click on Drug Coverage & Pricing Tool and then enter your ZIP Code. Each tier has a copay or coinsurance amount. Prescription Drug List By Tier Last Updated: 1/25/2021 Massachusetts Large Group 3-Tier Drug List. TTY/TDD users, please call 800-716-3231. Please consider talking to your doctor about prescribing preferred medications, which may help reduce your out-of-pocket costs. Each covered drug is in 1 of 5 drug tiers. Call the phone number on your health plan ID card. This list may help guide you and your doctor in selecting an appropriate medication for you. • New generic drugs. The price for a medication identiied as “Value-Priced” is listed below: • 30-day-supply drugs cost $5 (tier 1), $10 (tier 2) or $15 (tier 3) • 90-day-supply drugs cost $10 (tier 1), $20 (tier 2) or $30 (tier 3) October 2020 . For people 65+ or those who qualify due to a disability or special situation, For people who qualify for both Medicaid and Medicare, Plans for people before age 65 and coverage to add on to other health insurance, Additional plans like student or life insurance, View individual and family plans near you, Specialty medications not eligible for coupons, Advantage Tier 3 Prescription Drug List for UnitedHealthcare, Neighborhood Health Plan, River Valley, All Savers, and Oxford medical plans, Advantage Tier 4 Prescription Drug List for UnitedHealthcare, Golden Rule, UnitedHealthOne, Oxford, All Savers, Neighborhood Health Plan and River Valley medical plans, Access Tier 3 Prescription Drug List for UnitedHealthcare, Neighborhood Health Plan, River Valley and Oxford medical plans, Access Tier 4 Prescription Drug List for UnitedHealthcare, Neighborhood Health Plan, River Valley and Oxford medical plans, Traditional Tier 3 Prescription Drug List for UnitedHealthcare, River Valley, Oxford and Student Resources medical plans, Traditional Tier 4 Prescription Drug List for UnitedHealthcare and Student Resources medical plans, Essential Tier 4 Prescription Drug List for UnitedHealthcare, All Savers, Golden Rule, Neighborhood Health Plan and River Valley medical plans, Your Right to Request an Exclusion Exception, Standard Tier 4 PPO Prescription Drug List CDI Version, Standard Tier 4 HMO and PPO Prescription Drug List DMHC Version, Large Group Tier 3 PPO Prescription Drug List CDI Version, Large Group Tier 3 HMO and PPO Prescription Drug List DMHC Version, Large Group Tier 4 PPO Prescription Drug List CDI Version, Large Group Tier 4 HMO and PPO Prescription Drug List DMHC Version, Access Tier 3 PPO Prescription Drug List CDI Version, Access Tier 3 HMO and PPO Prescription Drug List DMHC Version, Access Tier 4 PPO Prescription Drug List CDI Version, Access Tier 4 HMO and PPO Prescription Drug List DMHC Version, Essential Tier 4 Prescription drug List DMHC Version, Essential Tier 4 Prescription Drug List DMHC Version, UHC Advantage Tier 3 Prescription Drug List, UHC Advantage Tier 4 Prescription Drug List, UHC Traditional Tier 3 Prescription Drug List, Oxford Advantage Tier 3 Prescription Drug List, Oxford Advantage Tier 4 Prescription Drug List, Oxford Traditional Tier 3 Prescription Drug List, Oxford Access Tier 3 Prescription Drug List, Traditional Tier 3 Prescription Drug List, Traditional Tier 4 Prescription Drug List, Advantage Plan Drugs Requiring Preauthorization, Traditional Plan Drugs Requiring Preauthorization, River Valley Pharmacy program 90/100 day list, Advantage and Essential Zero Cost Share Preventive Medications, Traditional, Access and Enhanced Zero Cost Share Preventive Medications, SignatureValue Zero Cost Share Preventive Medications, Advantage and Essential HMO and PPO Zero Cost Share Preventive Medications, Traditional, Access and Enhanced HMO and PPO Zero Cost Share Preventive Medications, Traditional and Access Zero Cost Share Preventive Medications, Emergency Contraceptive Services Only drug list, CT/DC/DE/IL/MA/MD/OR/WA Contraceptive Services Only drug list, Preventive Medication List: Core (5/1/2021), Preventive Medication List: Core (1/1/2021), Preventive Medication List: Core Plus (5/1/2021), Preventive Medication List: Core Plus (1/1/2021), Preventive Medication List: Expanded (5/1/2021), Preventive Medication List: Expanded (1/1/2021), Preventive Medication List: Federal Guided (5/1/2021), Preventive Medication List: Federal Guided (1/1/2021), Preventive Medication List: Universal (5/1/2021), Preventive Medication List: Universal (1/1/2021). 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