Frequently Asked Questions

More than half of all prescriptions filled today are for generics. Quite simply, the primary difference between a brand name drug and a generic is cost. The original drug developer has had to bear all the costs of research, development and bringing the drug to market, so their costs are generally much higher. Generic products must meet the same safety and therapeutic response as their brand name counterparts and must be approved by the FDA.

A Prescription Drug List (PDL) is also called a “Formulary.” It’s your way to see which medications may be covered on your specific plan. The Formulary also informs you if your medication requires prior authorization, has quantity limits or falls under “step therapy” (trying less expensive options before “stepping up” to more expensive drugs.) The Formulary is broken into cost levels called “tiers.” Choosing medications in a lower tier can save you money. Make sure to speak with your physician about finding prescriptions that might offer lower cost options.

Some prescriptions require prior approval, meaning you must get a plan “ok” before the medication can be covered. Once you receive authorization for this specific medication, you can get the prescription for your copay or your share of the cost.

When you are diagnosed with a condition where several treatments are available, you begin by trying the lowest cost treatment first.

There may be a limit on the number of pills you can order. This limitation helps us prevent stockpiling and misuse, and is one of our safety controls.

Check the Formulary available in your Member Portal.

Log into the Member Portal and print out another card from there.

Look up our Customer Service number you’ve saved to your phone. Our Customer Service department is ready to serve you 24/7 every day of the year. Contact us at 800-838-0007.

Definitely head to a network pharmacy whenever possible to maximize your prescription benefit. Click here for the “Find a Pharmacy” tool.

Complete the reimbursement form making sure to include:

• The original pharmacy receipt for each drug (not the register receipt) with the date the prescription was filled
• Prescription number (Rx#)
• Name and strength of drug
• Prescribing physician’s name or ID number
• Pharmacy name and address
• Quantity and days’ supply
• National Drug Code (NDC) number
• Compound ingredient information (if applicable)
• Amount paid

Claims are subject to your plan’s in-network or out-of-network allowances, minus applicable deductibles and copays.

You have 3 months from the original fill date to receive reimbursement.

We will message you within 15 days of receiving your claim to let you know if it has been approved or denied. If reimbursement is due, we’ll send you a check by mail within the same timeframe. Please allow time for the mail to arrive.

Once you log into the Member Portal, you’ll be able to check your claims status there. You can also call the Customer Service number on the back of your ID card.