Answers to Questions about Our Prescription Drug Program
Pharmaceutical manufacturers are spending more than ever before on advertising and promotions. New drugs continue to come on the market, and drug manufacturers continue to raise the price of drugs. More people are taking more prescriptions than ever before. The result is an increase in the cost of prescription drugs for you and everyone in our community.
What's being done to offset the high cost of prescription drugs?
Our three-tier drug benefit was designed to give you some relief from the increasing cost of prescription drugs.
This plan offers important advantages to you, including:
- Coverage for a wide range of medications.
- Protection for you if you need expensive medications.
- Opportunity for you to lower your out of pocket cost by using lower cost drugs whenever possible.
What does the three-tier drug benefit mean to me?
It means you will continue to have coverage for the prescription drugs you need. However, you may notice a difference in what you pay at the pharmacy. With this benefit design, your co-payment/coinsurance will vary depending on the tier in which your prescription drug is placed. Our goal is to encourage you to choose value in your prescriptions.
How are the tiers determined?
Clinical pharmacists and doctors who practice in our community, make up our Pharmacy and Therapeutics Committee. They review and evaluate the three-tier list on an on-going basis for clinical effectiveness, quality and value. For drugs in the most expensive category, Tier Three, there may be lower cost options in the Tier One or Tier Two categories.
What should I do if I am taking a Tier Three prescription?
You may want to talk to your doctor about the prescriptions you are taking. There may be a drug in the less expensive Tier One or Tier Two that meets your needs. Or, you and your doctor may decide to continue on your Tier Three medication. In this case, your benefit does provide coverage for you, but you will share in the cost of the drug through the higher co-payment/coinsurance.
If a prescribed drug has a retail price that is less than the applicable co-payment/coinsurance, how much will I pay?
You will pay the lower price.
Where can I purchase my prescription drugs?
You can buy your prescription drugs at any pharmacy that participates with the National pharmacy network.
Can I order my prescriptions by mail?
Yes. You may find this more convenient.
Where can I find more information about which tier my prescriptions are in?
Follow this link to view our current three-tier drug list.