The Ultimate Guide to
Your Pharmacy Benefits

Your plan gives you access to a large retail pharmacy network that includes thousands of pharmacies
throughout the U.S. To use your benefits:

• Visit your pharmacy benefits manager’s (PBM’s) website for a list of participating network pharmacies:

• Present your member ID card and prescription at a participating pharmacy.

Your formulary or drug list shows which brand-name and generic medications are covered by your plan. If your healthcare provider prescribes a medication that is not on the formulary/drug list, it will not be covered under the plan, and you may be responsible for the full cost of the medication. If your provider prescribes a medication that is not covered, you can ask to switch to an alternative that is covered under the plan.

To learn more about cost sharing with your plan, including copays and coinsurance, watch the short RxMinute video.

To confirm if a medication is covered under your formulary/drug list, visit your member portal or contact Member Services.

Learn more about drug coverage and formulary tiers in Guide to Your Pharmacy Benefits.

Your pharmacy benefits are designed to help you conveniently access prescriptions at the best possible cost. There are several ways to ensure you’re getting the best value, such as:

• Choosing generic over brand-name medications (generics typically cost 85% less than equivalent brand-name drugs).
• Requesting a 90-day medication supply.
• Having your prescription delivered through a mail-order pharmacy.

To learn more about generic and biosimilar medications, download the flyer.

For more cost savings tips, download the Don’t Waste Your Money flyer, or review the four questions you can ask your doctor to lower your out-of-pocket costs.

Certain medications may require a prior authorization (PA) review before you can fill the prescription under your pharmacy plan. The PA process ensures that prescribed medications are safe, appropriate, and cost efficient.

Step 1: Your healthcare provider submits a request along with supporting documentation, which could include chart notes and lab work.

Step 2: A clinician ensures the medication is being prescribed in accordance with U.S. Food and Drug Administration (FDA) approval criteria and clinical best practices, and that it is covered by your plan.

Step 3: If your medication is denied, your prescriber may recommend an alternative medication that is equally effective and covered by your plan.

To learn more, download the Prior Authorization FAQs or watch the short RxMinute PA video.

If you’re going out of town for an extended period and need extra medication, contact Member Services. To request an extra supply for a vacation, you must provide the representative with the date you’re leaving and the date you’re returning. RxBenefits will temporarily suspend the quantity limits plan rule, and you can pick up your medication at your local pharmacy.