The drug coverage level is a classification for drugs listed in our approved drug list (or formulary). The coverage level determines your copay. There are eight levels:
- Preferred generic: Equivalent or alternative to brand-name drugs, at the lowest cost-share possible.
- Generic: Equivalent or alternative to brand-name drugs, but they cost less.
- Preferred brand: Brand-name drug that requires a higher copay than generic, but a lower copay than a non-preferred drug. These drugs are commonly prescribed and selected based on their effectiveness.
- Non-preferred brand: Brand-name drug that requires an even higher level of copay. These drugs usually have lower-cost alternatives with the same or better effectiveness.
- Preferred specialty: Specialty drug that is selected based on its effectiveness, safety and cost-effectiveness. Specialty drugs require special handling, are self-administered and are used for chronic illnesses. They require an even higher copay than a brand-name drug.
- Non-preferred specialty: Specialty drug that requires the highest level of copay. These drugs usually have lower-cost alternatives with the same or better effectiveness.
- Medical benefit: Drug that is covered by your medical plan benefits instead of your prescription plan benefits. Check your coverage documents or call Customer Service for details.
- Excluded: Drug that is not covered by your plan and is never covered for any reason.
- Not covered: Drug that your prescription plan will not pay for or that is not included on the approved drug list. Contact Customer Service for more information.