HAP

Using your prescription coverage

What's covered?

Taking medicine can be vital part of your treatment plan. That is why it is so important to have prescription coverage. Prescription drugs are a covered benefit and include most FDA-approved medications.










HAP is always reviewing new drugs introduced to the market and may add or remove items on the drug formulary. A formulary is a list of covered drugs. Prescription drugs are self-administered drugs that you can obtain from pharmacies and that you use in the outpatient setting .

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How much is covered?

HAP uses a four tier prescription cost-sharing system. Refer to the Summary of Benefits and Coverage (SBC) for Plan specific cost-sharing information. Generic medications usually have the smallest cost-sharing amount.

  • Tier 1 - Generic Rx: most generic covered prescription drugs
  • Tier 2 - Preferred Rx: select brand prescription drugs
  • Tier 3 - Non Preferred Rx: brand prescription drugs with lower cost alternatives
  • Tier 4 - Specialty drugs

If an FDA-approved generic drug is available, your pharmacy will use the generic form of the medication.

The standard one month supply of a prescription drug is up to a 30-day supply. Specialty drugs, injectable drugs (except insulin) and select oral drugs (e.g. opioid analgesics) are limited to a maximum 30-day supply per fill. Some specialty drugs require a 15-day first fill.

HAP offers mail-order pharmacy services through Pharmacy Advantage, our contracted Specialty provider. You can get up to a 90-day supply of some medications (new prescriptions or a simple refill). This saves time and money, plus it eliminates trips to the pharmacy. If you need specialty drugs, those are required to be filled from Pharmacy Advantage.

 
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