Affordable prescription guide - employer sponsored plans
Affordable prescription guideEmployer-sponsored plans — January 2014
Here’s a list of the most commonly prescribed medications on the Priority Health approved drug list. Take this guide with you whenever you visit your doctor.
Remember, you’ll save money when you use generics or preferred brand drugs.
• Generics (least expensive) are listed in lowercase
• Preferred brands are listed in UPPERCASE
This list isn’t all-inclusive, and coverage varies based on your employer’s plan. Coverage is not guaranteed and this list is subject to change. To verify coverage and see a complete list of approved drugs, go to priorityhealth.com
or contact Customer Service using the phone number on the back of your Priority Health ID card.
Benign Prostatic Hyperplasia
Calcium Channel Blockers
Cholesterol Lowering (statins)
H2 Receptor Antagonist
Proton Pump Inhibitors (PPIs)
Central Nervous System
Diabetic Test Strips
ACTONELalendronatecalcitonin-salmonibandronatePROLIA (PA)zoledronic acid
Pain Management (opioids)
APAP/codeineAVINZAfentanyl patchhydrocodone/APAP 325mg methadonemorphine sulfate/EROXYCONTINtramadol/ER
PULMICORT (tier 1 copay)
QVAR (tier 1 copay) Steroids (Nasal)
• triamcinolone acetate
• OMNARISSteroid/LABA combos
DULERA (tier 1 copay)
SYMBICORT (tier 1 copay) Quick Relief Inhalers
Over-the-counter (OTC) medications
Medications that do not require a prescription are not covered under the pharmacy benefit unless specifically listed. Employer-sponsored plans currently cover Prilosec OTC, Prevacid OTC, Zegerid OTC, and Zaditor OTC with a prescription.
Pharmacy & Therapeutics Committee
Doctors, pharmacists and other health care professionals from the Priority Health network meet six times a year to research and review the newest drugs on the market. Because of this attention to detail, you can be confident that our list is up-to-date with the highest quality, most effective choices to meet your needs. Cost is only a consideration when medical evidence shows that less expensive drugs in the same class are equally safe and effective.
Quantity limits and prior authorization
Certain medications may have monthly quantity limits (QL) or require prior authorization (PA) to ensure safe and appropriate use. Approval forms are available at priorityhealth.com
and your doctor may submit a request by faxing 877.974.4411. You and your doctor will be notified regarding the decision within 15 days.
Some medications require step therapy because there are other drugs in the same category that are just as safe and effective but may cost less. This provides a safe alternative and saves you money. If the lower cost drug isn’t effective or if it is medically necessary your doctor can work with Priority Health and request an exception.
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