A drug list or formulary is a list of generic and brand-name prescription drugs covered by your health plan. Although a drug may be on the drug list, it might not be covered under your plan. Review your certificate of coverage or other plan materials for details on your prescription drug benefits.
An independent group of practicing pharmacists and physicians, the Pharmacy and Therapeutics Committee, reviews all available drugs on an ongoing basis and then selects those that are considered "best choices." They review scientific literature and reports, consult with other health care professionals and use their own expertise to make their decisions.
Before a drug is included in the drug list, it must pass a strict review by the committee, based on these criteria:
Often, there are many drugs available to treat the same condition. In some cases, two drugs are equivalent in effectiveness and safety. In this case, the preferred drug included on the drug list will be the lower-cost drug. We negotiate discounts on behalf of our members. We pass these savings on to you by holding down prescription drug coverage costs.
Remember, not all benefit plans are subject to the prescription drug list. Check your certificate or other plan information for benefit details.
If your pharmacy benefit includes mail order, then CCStpa offers a service administered by Prime Therapeutics. With the PrimeMail™ pharmacy, you get home delivery of your prescription drugs with the highest standards of quality, safety and service.
PrimeMail offers you the convenience of ordering the maximum days' supply (typically, a 90 days' supply) of maintenance drugs at one time. Maintenance drugs are those drugs you take on an ongoing basis.
Many health plans offer a significant discount for choosing to refill medications through the mail service versus a retail pharmacy. Check your prescription benefit details for more information.
Specialty drugs are for serious or chronic conditions such as multiple sclerosis, hemophilia, hepatitis, and rheumatoid arthritis. Order them from a specialty network pharmacy to get convenient home delivery, savings and support.
Some of our health plans cover some over-the-counter drugs: some antihistamines and proton pump inhibitors for acid-related stomach disorders. These can cost much less than prescription versions. Receive these drugs, equally as effective as the prescription versions, at a lower cost to you.
If you have prescriptions that you fill regularly, you can save money by getting a three-month supply at once.
A step therapy program is a "step" approach to providing drug coverage. It is designed to encourage the use of cost-effective prescription drugs when appropriate. This means that you may first need to try an alternative, typically a generic drug, before we will cover certain medications prescribed by your doctor.
You'll need to mail your first prescription to PrimeMail. To get started, fill out and send in the patient profile and order form.
Visit MyPrime.com to register for the first time for PrimeMail's mail order pharmacy service or to order a prescription refill.
Call toll free 1-877-357-7463 and use PrimeMail's automated refill line or speak with a customer service representative.
You can also use MyPrime.com to get drug cost estimates or check drug interactions. Compare estimated retail versus mail order costs for any given drug, or view drug-to-drug or drug-to-food interaction information.