Pharmacy Program Updates

Updates are made to our pharmacy program as needed. A notification letter is sent to members impacted by a pharmacy program change when:

  • A drug is being excluded from the formulary (drug list).
  • A drug is being added to a pharmacy program, such as Prior Authorization, Quantity Management or Step Therapy.

The six-tier pharmacy copay benefit is in place to better allow management of the always changing prices of drugs in the marketplace. As drug prices change and new generic medicines come into the market, you may see a change in the copay for the brand drugs that now have a generic. As the new generics become more available in the market, you may also see the copay for the generic drug increase or decrease to align with the changing cost of the drug. These changing copays are in place to better manage the pharmacy benefit and make the overall cost of health insurance more affordable.

Here are the most recent updates by category: