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This section of your online member
handbook explains:
How do I know if I have prescription drug coverage? How does my prescription drug coverage work? Do I have to pay a deductible or copayment for my prescriptions? What is the Approved Drug List? What if the medication I take is not on my plan's formulary? What is the difference between generic and brand name drugs? What is the benefit of using generic drugs? How can I get my prescriptions filled by mail? How can I save money on my prescriptions? Q: How do I know if I have prescription drug coverage? A: Look for prescription drug information (called a "prescription rider") in the packet of information you received from Priority Health. You can also check your coverage documents - either a Certificate of Coverage booklet or your insurance policy. Standard documents are available here online, but your employer's plan may differ. Not all Priority Health plans include prescription coverage. Call Customer Service if you have questions. Back to Top Q: How does my prescription drug coverage work? A: If your plan has prescription drug coverage, you can get up to a 31-day supply of your covered prescriptions for one copayment. To maximize your savings:
Back to Top Q: Do I have to pay a deductible or copayment for my prescriptions? A: When you log in here at priorityhealth.com and see your personal member account information, you can see your deductible balance (if you have a deductible) and any drug copayments, doctor visit copayments, etc. This information was included in your packet of information from Priority Health when you enrolled; look for the Schedule of Copayments and Deductibles. It provides information about your costs for health care services and the maximum limitations of your health care benefits. Back to Top Q: What is the Approved Drug List? A: An Approved Drug List, also called a formulary, is a list of drugs approved for coverage under that plan. Drugs are added to the list or removed by a committee of local doctors and pharmacists as well as Priority Health staff, who review research to find which drugs are most effective. Each Priority Health plan - PriorityHMOSM, PriorityPOSSM, PriorityPPOSM - has an Approved Drug List. To see which drugs are covered by your plan (if you have prescription coverage), use the online Approved Drug List tool. Back to Top Q: What if the medication I take is not on my plan's formulary? A: If your drug is not on the Approved Drugs List for your Priority Health plan, you might have to pay the full price of that drug instead of just a copayment. Talk to your Primary Care doctor or other primary health care provider. He or she usually can prescribe an alternative medication that is on the list. Back to Top Q: What is the difference between generic and brand-name drugs? A: The brand name is the name given to a drug by the company that invented or patented it. The generic name is usually a drug's chemical name. "Generic equivalents" have the same active ingredients and are available in the same strength and dosage as brand-name products. Generic equivalents meet FDA requirements, which are equivalent to requirements for the brand-name products. "Generic alternatives" are drugs that treat the same conditions as brand-name drugs. They also meet FDA requirements for safety and effectiveness. Generic drugs cost an average of 40% to 60% less than brand-name drugs. For list of approved generic drugs, see the Approved Drug List. Learn more in: Back to Top Q: What is the benefit of using generic drugs? A: Generic equivalent drugs have the same active ingredients and are available in the same strength and dosage form as brand-name products. Generic drugs meet FDA requirements, which are equivalent to requirements for the brand-name products. They're safe, effective and cost less - an average of 40% to 60% less than brand-name drugs. If you have prescription drug coverage, ask your Primary Care Provider to prescribe generic or preferred brand-name drugs. For list of approved generic drugs, go to the Approved Drug List in the Medication Center. Learn more in:
Q: How can I get my prescriptions filled by mail? A: If you have ongoing prescriptions (longer than 30 days) you may be able to save more money with our mail-order pharmacy program. It lets qualified members get up to a 90-day supply of their regular prescriptions for one or two copayments instead of three. Check your prescription drug rider for your plan's specific prescription coverage and mail-order copayments. If you are covered for mail-order, have your doctor write your prescription for a 90-day supply, fill out a Walgreens Mail Service registration form (PDF*) and send it with your copayment or credit card information to the address supplied on the form. Allow 14 days for delivery of your prescription. Q: How can I save money on my prescriptions? A: Besides ordering your drugs from the mail service pharmacy in 90-day quantities and asking your doctor to prescribe generic drugs whenever possible, you can call pharmacies in your area and ask what your prescription might cost. You'd be surprised at the difference from one pharmacy to another. Read more about saving money on your prescriptions: Back to Top You'll need Adobe Reader software to view and print PDF files. Download it free now! 
Last modified
11/20/08
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