We focus on the health of our members when we develop our drug list. We use the strongest clinical studies to make drug list decisions. We encourage drugs that help improve health. We see how drugs work in real life for members. And, we use our member data, including pharmacy, medical and lab data, to see how drugs are really working.
Our drug list is made up of brand and generic prescription drugs, but we don’t choose just any medication. We do not include all FDA-approved drugs as preferred on our drug list. We consider the impact a drug may have on total health care costs (pharmacy + medical). We look at drug cost after we look at how well a drug improves health. And, we don’t base our decisions solely on rebates.
Pharmacy & Therapeutics Process
A group of doctors and pharmacists – who are not our employees – lead the selection of drugs for our drug lists. This group performs regular clinical reviews, rates drugs based on how they work in real life, evaluates drug costs to make sure they are affordable, and chooses drugs that are safe, work well and offer the best value.
Outcomes-Based Drug List
Our Drug List contains covered prescription medications approved by the U.S. Food and Drug Administration (FDA). The list is made up of hundreds of brand and generic medications. The drug list has “tiers” for most products, which means Tier 1 drugs have the most affordable copayment while copayments for drugs on Tiers 2, 3 and 4 are higher.