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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