Prescription Drug Coverage

 
 

Healthy Focus

Prescription Drug Coverage

Prescription Drug Coverage

If you are enrolled in one of the Healthy Focus medical plans, you have access to prescription drug coverage through Express Scripts. Below is the plan design for our prescription drug program.

For annual formulary updates, refer to the 2017 Preferred Drug List of Exclusions.

For non-preventive prescription drugs, you must meet the annual deductible before the plan pays the majority of the cost. There’s no deductible for certain preventive drugs and lower costs for select maintenance preventive drugs. View the 2017 preventive drug list.

Looking for pricing for your medication? Please visit the Express Scripts enrollment site.

  Healthy Focus Advantage Healthy Focus Essential
  Network Out-of-Network Network Out-of-Network

Generic

$5 after deductible

$5 after deductible

Formulary (Preferred Brand)

30% after deductible

30% after deductible

Non-Formulary (Non-Preferred Brand)

50% after deductible

50% after deductible

Prior Authorization

Prior authorization is a feature of your prescription benefits plan that helps ensure the appropriate use of selected prescription drugs. Certain prescription drugs require your doctor to get approval before they're covered. This process helps make sure you receive the right medicine in the correct dose, which is very important if you're taking a specialty drug. These medicines are only approved for specific conditions and usually require keeping in close touch with your doctor. Prior authorization takes the extra step to watch specialty drugs.

Read the FAQs to learn more.

Step Therapy

Step Therapy is an approach intended to control the costs and risks posed by certain prescription drugs. It begins with a drug therapy for a medical condition with the most cost-effective and safest drug therapy and progresses to other more costly or risky drug therapies only if necessary. Here’s an example of step therapy:

  • You try an over-the-counter medication for an allergy, but it doesn't control your symptoms.
  • Your doctor prescribes a prescription drug that still doesn't give you relief.
  • A third medication that's more expensive works well, but requires step therapy.

In this case, your prescription is covered if you've tried the first choice drugs.

Read the FAQs to learn more.