Our contact information is on the cover. The chart below shows the differences between the tiers. 6 - drug list updated 03/2020 for pdl007 drug name drug level utilization management requirements 1st tier unifine pentips 29 gauge x 1/2" needlemm 1 1st tier unifine pentips 31 gauge x 1/4" needlemm 1 1st tier unifine pentips 31 gauge x 3/16" needlemm 1 1st tier unifine pentips 31 gauge x 5/16" needlemm 1 1st tier … If you have questions about a medication that is not on the comprehensive drug list, please call customer service at 800-340-1305, 24 hours a day, seven days a week.   Call the phone number on your health plan ID card. There are thousands of drugs listed on the Tufts Health Plan covered drug list. 4-Tier Prescription Drug List, January 2021. For Standard Option and Basic Option, you will generally pay the lowest cost share for any Tier 1 generic drug or Tier 4 Preferred specialty drug. Florida Medicaid Preferred Drug List, opens new window. The numbers in the Tier column on the prescription drug formulary indicate the cost share for the medication. 0 20201 COMPLETE DRUG LIST (FORMULARY) Prescription drug list information UnitedHealthcare® Group Medicare Advantage (PPO) ... • Your drug’s tier. Select the drug form, strength and dosage. In general, the lower the drug tier the more cost effective the drug. This list may help guide you and your doctor in selecting an appropriate medication for you. There are three documents in the Formulary column. The price for a medication identiied as “Value-Priced” is listed below: • 30-day-supply drugs cost $5 (tier 1), $10 (tier 2) or $15 (tier 3) • 90-day-supply drugs cost $10 (tier 1), $20 (tier 2) or $30 (tier 3) This comprehensive drug list is a list of drugs specifically covered by your plan. 520 0 obj <>stream This list may help guide you and your doctor in selecting an appropriate medication for you. endstream endobj 498 0 obj <> endobj 499 0 obj <> endobj 500 0 obj <>stream Tier Number - This is the actual numerical tier level from the formulary. If you need help or have any questions about your drug costs, please review your Evidence of Coverage or call Member Services. Tier 4 - Coverage for this tier is for “specialty” drugs used to treat complex, chronic conditions that may require special This list may help guide you and your doctor in selecting an appropriate medication for you. replacing it with a new generic drug that will appear on the same or lower cost sharing tier and with the same or fewer restrictions. October 2020 . Yes. This PDL applies to members of our UnitedHealthcare, Neighborhood Health Plan, River Valley, All Savers and … Members are encouraged to show this list to their physicians and pharmacists. A formulary generally lists many drugs and ranks them in groups described as tiers.2 Tier 1 drugs generally don't require pre-authorization and often will cost you little, if any, co-pay. Use the Drug Coverage & Pricing Tool Click on Drug Coverage & Pricing Tool and then enter your ZIP Code. Also, when adding the new generic drug, we may decide to keep the brand-name drug on our Drug List… Medication List, which is divided into two sections, “Value Priced” Medications and “Discounted” Medications*. Some subtypes have five tiers of coverage. 2021 Prescription Drug Guide – Spanish, PDF opens new window Please consider talking to your doctor about prescribing preferred medications, which may help reduce your out-of-pocket costs. The drug list is regularly updated. Each covered drug is in 1 of 5 drug tiers. "�8%L�p� Tier 1 or Tier I: Tier 1 drugs are usually limited to generic drug… Prescription Drug List By Tier Last Updated: 1/25/2021 Massachusetts Large Group 3-Tier Drug List. These costs are decided by your employer or health plan. The PDL applies only to prescription medications that a PHP Member picks There is, however, a list of drugs that Tufts Health Plan currently does not cover. 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