Prescription drug benefits

Also known as the list of covered drugs or drug list, a formulary is a list of drugs, chosen by a team of doctors and pharmacists, that are covered by your health plan. It’s divided into tiers, and generally drugs on lower tiers will cost less than drugs on higher tiers. The formulary can also change during the calendar year. For example, new FDA approved drugs may be added to the formulary or drugs may be removed due to a safety concern. Search for your drugs on your current plan year’s formulary.

In your online member account, you can visit our pharmacy benefit manager portal, Navitus Health Solutions. Through Navitus, you can use real-time benefit tools to price your drugs, find alternative medicines and more.

All members can check their current plan year’s documents and forms for more information about their drug costs.

Use the pharmacy search tool to find a pharmacy in your health plan’s network.

In order for your prescription drugs to be covered by your health plan, make sure to get them from in-network pharmacies. Use our search tool to find a pharmacy in your health plan’s network.

There are a number of ways for members to save money on their prescription drugs.

Make sure your drug is in your plan’s formulary

Your health plan’s drug benefits help to cover the cost of prescription drugs that are listed on your health plan’s formulary. If you’re prescribed a drug that isn’t on your health plan’s drug list and you don’t receive prior authorization from UCare, you may be responsible for paying the full cost of the medication, which can be very expensive. Search for your drugs on your current plan year’s formulary or check your current plan year’s documents and forms for more information about prior authorization. If you’re prescribed a drug that isn’t on the formulary, talk to your provider about possible alternatives that are on your plan’s drug list.

Consider generic drugs

A generic drug is a medication created to be the same as an already-marketed brand drug. That means that a generic drug works in the same way and provides the same clinical benefit as the brand-name medicine. Generic drugs are usually much cheaper than their brand-name alternative. This is because generic drug manufacturers don’t have to duplicate the original clinical trials for effectiveness and safety. The brand drug manufacturer already conducted these for the brand-name drug’s ingredients, which are the same or very similar to the generic. Talk with your provider about possible generic options for prescribed medications to lower your costs.

Use an in-network pharmacy

Staying in your health plan’s network allows you to save money. That’s because negotiated rates for health care don't apply to care received by providers outside the plan’s network. So, you’ll typically pay quite a bit more if you visit an out-of-network pharmacy. Use the pharmacy search tool to check if your pharmacy is in your health plan’s network or find one that is in-network.