A drug formulary is a list of FDA-approved generic and brand-name prescription drugs and supplies covered by ESI. ESI places covered drugs into three levels: preferred generic, preferred brand or non-preferred.
Preferred drugs are covered at a lower cost to you. Non-preferred drugs are covered, but you will pay more than if you choose preferred generic or preferred brand drugs. If your health care provider prescribes a non-preferred drug, discuss preferred alternative options with your provider.
There are some drugs that are not covered. These drugs have a covered alternative option that can be discussed with your provider. In most cases, if you fill a prescription for one of these drugs, you will pay the full retail price. Your provider may request a clinical exception to cover the drug by calling Express Scripts’ Prior Authorization Line. Approved exceptions are covered as a non-preferred drug.
ESI’s preferred formulary list is available here (2019 Formulary) or by contacting ESI, and can change throughout the year. If you have a question about a drug you take, please call ESI at 800-797-5754.
Brand-for-Generic Substitution Program
The plan will prefer select brand drugs, as decided by ESI, and not cover their higher net-cost generic equivalent. Members will pay the generic copayment for the brand in this program.
There are certain medications that MCHCP will cover at 100%, when accompanied by a prescription and filled at a network pharmacy. See Preventive Services for more information.
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