*Drugs are placed into each level based on decisions made by our Pharmacy and Therapeutics (P&T) Committee. This team of community doctors and pharmacists meets regularly to collaboratively review the most current medical studies and make updates to our Preferred Drug List.
Preventive drug benefit
Our preventive drug benefits are HSA-qualified and provide full coverage to ensure that members have access to medications that are determined to help keep conditions from getting worse. Deductibles, copays, or coinsurances are waived for certain generic medications that treat cardiovascular disease and diabetes.
Consult the HSA Generic Preventive Drug List to see if your drug is included in this benefit.
Value-based drug benefit
With a value-based drug benefit, your prescription medications fall into one of four categories or “levels.” Each level has a different copay or coinsurance. Under the value-based drug benefit, medications are categorized by level based on their quality, value, and effectiveness -- not by their generic, brand-name, or specialty drug label. So, for this benefit each level may contain a combination of generic, brand-name, and specialty drugs.
Four-level drug benefit
Level 1 - Low cost share
Level 2 - Moderate cost share
Level 3 - High cost share
Level 4 - Highest cost share
Preventive Drugs - Certain generic preventive drugs will have a very low or no cost share
Who decides a drug's value?
A drug's value is based on science. An independent set of experts made up of leading physicians, pharmacists, health economists, a bioethicist, and a member representative review new and existing drugs. The drugs are evaluated on how well they work relative to their cost and how their effectiveness compares to similar drugs used to treat the same condition.