Drug information

The drug list, or formulary, features generic and brand-name drugs to help you manage your costs and health. You can use the drug list to learn which drugs are covered and what your share of the cost is. Our drug list has 5 tiers, or levels. Generally, drugs on tier 1 will be the least expensive and drugs on tier 5 will be more expensive.

Search the drug list

About the drug list

Our drug list is a list of drugs that are covered by the plan. Journey Rx and a team of health care professionals create the list by selecting drugs that provide the best value and effectiveness. Journey Rx will generally cover drugs listed on the drug list if the drug is medically necessary, the prescription is filled at a network pharmacy and other plan rules are followed.

If your drug isn’t covered on the drug list or has certain restrictions

Your prescriber may be able to prescribe a different drug that is covered. If an alternative drug is not available or will not be as effective, you, your prescriber or your appointed representative can request a coverage determination.

Changes to the drug list

Drugs can be added and removed from the drug list throughout the year. If we remove drugs from the drug list, add restrictions to a drug (e.g., prior authorization, quantity limit, step therapy) or move a drug to a higher tier, we will notify members who take the drug at least 30 days before the change takes place.

If the Food and Drug Administration determines a drug on the drug list to be unsafe, or if the drug manufacturer removes the drug from the market, we will immediately remove the drug from the drug list and provide notice to members who take the drug.

Common drug coverage rules

Some prescription drugs have special rules that regulate how and when the plan covers them. These rules help us keep your drug coverage costs affordable. There are three types of drug coverage rules that may apply:

If you want to have a coverage rule waived, you can request an exception through the coverage decision, or coverage determination, process. Learn more about common coverage rules below and contact us if you have questions or need assistance.

Check the drug list to see if a drug you currently take or would like to take has any coverage rules.

Prior authorization

If a drug you take or want to take has this rule, it means you or your prescriber need to get approval from the plan before it can be covered. Once the drug is authorized, you can fill the prescription at any network pharmacy (you may save more at a network pharmacy offering preferred cost sharing).

» Learn how to request a prior authorization

Quantity limits

Some drugs may have a limit on how much you can get each time you fill a prescription. For example, if it is normally considered safe to take one pill per day for a certain drug, the plan may limit coverage to one pill per day. You don’t have to take any extra steps to have your drugs covered as long as your medications are prescribed within the quantity limits.

» Learn how to request a quantity limit exception

Step therapy

This requirement encourages you to try a less costly but just as effective drug before the plan covers another drug. For example, if Drug A and Drug B treat the same condition but Drug A is less expensive, you may need to try Drug A first. If Drug A doesn’t work, the plan will then cover Drug B.

» Learn how to request a drug that has step therapy requirements

Content Section