Using the Approved Drug List
Your prescription coverage is based on an "approved drug list," also called a formulary, which is a list of medications that Priority Health will cover for you. Different plans may have slightly different lists.
To find out what's covered for you:
- Click on the Approved Drug List link in Quick links.
- Optional: Log in, so we can show you your copay for each drug.
- Enter the drug name, or search the alphabetical listing for it.
- If you haven't logged in, you'll have to choose your plan. (Different plans have different approved drugs.)
- Check the "Coverage level" column to see if your drug is covered, and if so, what level - generic, preferred, etc.
- Check the "Coverage details." In some cases, you may find that your prescription:
- Requires prior authorization from Priority Health, which means your doctor needs to get approval from Priority Health to prescribe it for you. If you don't get "prior authorization" up front, you will have to pay your pharmacy the full price of the drug, not just your copay.
- Requires "step therapy," which means that you first have to try another medication or medications. If it/they don't work for you, then the drug may be covered for you.
New members may qualify for a refill of a non-approved drug
Learn how to request one.
Learn more about using the Approved Drug List
Check out our FAQs.
