It can be difficult to figure out which prescription drugs are covered under your plan. We're here to help you get the answers you need.
Let's start with how prescription drug coverage works. Your Asuris health plan will help pay for the cost of certain prescription medications. To find out which ones—and to avoid paying more than you expect—you can look at your covered-drug list.
What is a covered-drug list?
Also called a formulary, a covered-drug list is the list of drugs that are covered by your health plan. In other words, it's a list of pre-approved drugs that Asuris helps cover, so when you fill your prescription, you don't have to pay full price.
Your covered-drug list is designed to help you and your doctor choose medications that are safe, effective and cost-conscious. We regularly update our list to keep up with new drugs, safety data, information from the FDA, clinical trial results and the recommendations of pharmacists and doctors.
How does my covered-drug list work?
Your covered-drug list is split into tiers, usually ranging from three to six tiers, depending on your plan.
Six-tier drug lists usually include three drug categories: Generic, brand and specialty medications. They also offer a preferred tier for each category. Medications in the preferred tiers will usually have the lowest cost to you.
Below is an example of a six-tier covered-drug list:
How do I find my covered-drug list?
To view your covered-drug list, go to your Pharmacy benefits on asuris.com. Sign in and select See pharmacy forms. Your drug list will be listed at the top of the page and will be called something like "Three Tier Drug List" or "Six Tier Drug List." You can click to view or download a PDF of your list.
Pre-authorization and other requirements
Some medications require pre-authorization in order to be covered by your plan. Pre-authorization supports coverage of safe, effective and high-value medications, helping you and your doctor choose quality medications that provide the most value. (Tip: Drugs that require pre-authorization often have an alternative on the covered-drug list that does not require pre-authorization.)
How do you know if your medication requires pre-authorization? You can check your covered drug list, or go to your Pharmacy benefits, sign in and use Find a drug. The results will tell you if pre-authorization is needed.
In addition to pre-authorization, there are a few other requirements or limitations that might apply to your medication:
- Quantity limits – Sometimes we only cover a certain amount of the medication, because too much may be a safety concern. If your doctor prescribes more than this limit, you may request an exception.
- Specialty drugs – These drugs are limited to a 30-day supply and may be required to be filled through our designated Specialty Pharmacy. This service can help you coordinate refills and monitor side effects, plus it gives you 24-hour access to clinical specialists.
- Step therapy – Before using some new or costly drugs, you must first try a lower-priced medication that treats your condition.
If you have questions about pre-authorization or other requirements, call Pharmacy Customer Service at 1 (844) 765-2895.
Prescription costs and how to save
What you pay for your medications will depend on your plan. To see your pharmacy coverage and the percentage of prescriptions you'll pay, go to your Benefits & coverage and select the Pharmacy tab.
To find the cost of your medication, go to your Pharmacy benefits, sign in and use Find a drug. Find a pharmacy lets you search pharmacies in your network and compare medication costs.
If your health plan includes MedSavvy®, you can easily compare prices to see if there's an equally effective and more affordable option. MedSavvy also shows you grades for safety and effectiveness, so you can be sure you're choosing the best medication for your health and your wallet.
Need more help cutting down prescription costs? We've got some tips to save on medications.
Lastly, it's important to be open with your doctor about costs and using a preferred drug on your covered-drug list when possible.
We're here to help
Prescription coverage can be complicated. But by reviewing your covered-drug list and getting to know your pharmacy benefits, you'll have a better idea of how much you'll pay for medications.
If you have questions about what's covered, pre-authorization or anything else, reach out to Pharmacy Customer Service at 1 (844) 765-2895.