Oregon/Washington brokers: drug list changes for Q1 2018

ThinkstockPhotos-122524533_jpgCommercial formularies/drug lists for all Commercial lines of business in Oregon and Washington are updated for Q1 2018.

 

 

 

Health Net’s Drug Lists are updated quarterly and available online:

To view online, go to www.healthnet.com/broker > Select Your State (Oregon or Washington) > Pharmacy Plan Information > View our Drug Lists.

  • The Essential Rx Drug List (EDL) is an Affordable Care Act-compliant formulary used by Commercial members (IFP, Small and Large Group members).
  • The Aon Active Health Exchange Drug List (ADL) is used by groups/members who sign up under the Aon Hewitt private exchange.

You may also view the current PDF here.

To use the Drug Lists:
  • Review the Supplemental Prescription Benefit Schedule to determine the copayment and/or coinsurance amounts paid on medications under the member’s plan.
  • Search the drug list for the medications being used. The tier (1, 2, 3, SP and AC) corresponds to the copayment and/or coinsurance that the member will be responsible for.
  • Members taking medications that are not included on the list should contact Health Net’s Customer Contact Center 1-888-802-7001 as soon as possible to prevent interruption of a prescription. The representatives can answer questions, suggest alternative medications, or explain the steps to take if the drug requires prior authorization. Generally, drugs not listed on the EDL are subject to a Tier 3 copayment and/or coinsurance, unless excluded by the pharmacy benefit.

A lower tier generally indicates a lower copayment and/or coinsurance. For example, a Tier 1 drug would generally have the lowest plan copayment and/or coinsurance. Please take special note of any comments that accompany the medication.

Please be sure to visit our website at www.healthnet.com to view the most current version of our drug list.

Important tip to share with your clients: 

Members can generally save money by using generic versions of most medications, with equivalent results. It is always recommended that a pharmacist, physician or a Health Net Pharmacy Services representative be consulted to check if any drug has a generic version.

For questions, please contact your Health Net Representative.

 

 

 

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Bret Smith