5.-TIER UNIVERA (CY2022)

Welcome

Our plan covers generic and brand name drugs. A generic drug contains the same active ingredient and has the same therapeutic effect as the brand name drug. Generic drugs generally cost less than their brand name drugs. Generic drugs are rated by the Food and Drug Administration (FDA) to be as safe and effective as the brand name

What is a Formulary?

A formulary is a list of covered drugs which represents the prescription therapies believed to be a necessary part of a quality treatment program. We will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a network pharmacy, and other plan rules are followed. For more information on how to fill your prescriptions, please review your Evidence of Coverage.

Printable Files

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• Notice of Changes
• Formulary Change History

How to Search For Drugs

• Use the alphabetical list to search by the first letter of your medication.
• Search by typing part of the generic (chemical) and brand (trade) names.

How to Request an Exception

You can ask us to make an exception to our coverage rules. There are several types of exceptions that you can ask us to make:

• You can ask us to cover your drug even if it is not on our formulary.
• You can ask us to waive coverage restrictions or limits on your drug.
• You may ask us to pay a lower price for a covered non-preferred Part D drug through the tier exception process.

You should contact us to ask for an initial coverage decision for a formulary, tiering or utilization restriction exception. When you are requesting a formulary, tiering or utilization restriction exception you should submit a statement from your physician supporting your request. Generally, we must make our decision within 72 hours of getting your prescribing physician’s supporting statement. You can request an expedited (fast) exception if you or your doctor believe that your health could be seriously harmed by waiting up to 72 hours for a decision. If your request to expedite is granted, we must give you a decision no later than 24 hours after we get your prescribing physician’s supporting statement.Click here for more information.

More Information

Visit our Part D website for more information about prescription drugs, managing your medications and ways to save on drugs. You can also call Customer Care at 1-877-883-9577, (TTY users, 1-800-421-1220), Monday – Friday, 8:00 a.m. – 8:00 p.m.; From October 1 to March 31, 8:00 a.m – 8:p.m., seven days a week.