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Within the formulary, prescription drugs are divided into tiers. Depending on your plan, prescription drugs fall into one of five drug tiers which determines the price you pay.
Some plans may have 3, 4 or 5 tiers, so be sure to check your benefits information to see which tiers are included. Members can view specific cost-share copay or coinsurance information by logging in to My Account to access the Drug Pricing Tool or by reviewing their annual summary of benefits. Here's Why. Skip Navigation. Login Register. Have questions about health insurance? Explore our Insurance Basics pages.
Need Insurance? Log In or Register. Oral chemotherapy drugs and diabetic supplies e. Medications do not work if they are not taken as prescribed. Pharmacists are alerted to gaps in care and non-adherence and provide in-person one-on-one counseling when the prescription is filled at a CVS pharmacy. If the prescription is filled through mail order or at other network pharmacies, one-on-one telephonic counseling is offered to help you stay on track.
The pharmacist will provide personalized tips and support to help you stay adherent to your medications and identify potential opportunities for you to save money on your prescriptions. To ensure you are receiving the most appropriate medication for your condition s , certain medications have prescription guidelines. To see whether your drug requires prior authorization, step therapy or quantity limits, use our Drug Search. If you fill a non-preferred brand drug when a generic alternative is available, you will pay the non-preferred brand copay or coinsurance plus the cost difference between the generic and non-preferred brand drug, even if your doctor states Dispense as Written DAW on the prescription.
There is an exception process if you need the brand-name drug to be covered for medical necessity reasons. Your doctor may submit a brand exception request. To view this form, check our Drug Forms. Prior authorization is required before you fill prescriptions for certain drugs.
Your doctor must obtain prior authorization before they can be filled. Without prior authorization approval, your drugs may not be covered. Step therapy ensures you receive a lower-cost drug option as the first step in treating certain health conditions.
When similar drugs are available, step therapy guides your doctor to prescribe the lower-cost option first. You may then move up the cost levels until you find the drug that works best for you. Higher step drugs may require prior authorization by your doctor before they can be covered. Quantity limits are placed on selected drugs for safety, quality or utilization reasons. Limits may be placed on the amount of the drug covered per prescription or for a defined period of time.
If your doctor decides that a different quantity of medication is right for you, your doctor can request prior authorization for coverage. Some drugs may not be covered on your formulary, or may have quantity limits. There is an exception process if you need an excluded drug, or an additional quantity, to be covered for medical necessity reasons. Your provider can submit a request on your behalf by contacting Prescription drug benefits.
Drug Tiers The prescription drugs covered on the CareFirst formulary drug list are reviewed and approved by an independent national committee comprised of physicians, pharmacists and other healthcare professionals who make sure they are safe and clinically effective. Tier 1: Generic Drugs. Tier 2: Preferred Brand Drugs.
WebA formulary is a list of covered prescription drugs. Our drug list is reviewed and approved by an independent national committee comprised of physicians, pharmacists and other . WebThe prescription drugs covered on the CareFirst formulary (drug list) are reviewed and approved by an independent national committee comprised of physicians, pharmacists . WebPreferred Drug Lists Pharmacy Resources Help your CareFirst patients manage their prescriptions and drug costs. View the preferred drug lists for our members. Preferred .