Using your prescription coverage
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 .
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.