Prescription drug coverage
Learn the ins and outs of prescription drug coverage, including what's covered under your plan.
Prescription coverage
What’s covered and how to use your benefits
Our drug list, also known as a formulary, contains a detailed overview of the drugs we cover, along with the copay amount for each.
Use our drug finder tool to search for drugs that HAP covers. Some covered drugs may have requirements or limits. These are displayed in our drug finder tool, when you search for the drug
Prior authorization
You or your doctor must get approval from HAP before your prescription is filled.
Step therapy
In some cases, HAP may require you to first try a certain drug to treat your condition before another drug is covered.
Quantity limits
A limit on the amount of medication you can receive.
Specialty pharmacy
Prescriptions must be filled through our partner, Pharmacy Advantage.
The out-of-pocket costs for drugs are defined by tiers. For qualified health plans, they are:
- Tier 1: Preferred Generic - non-brand name drugs that have the lowest copay.
- Tier 1A: Generic - non-brand name drugs that are designated by us to be non-preferred generic
- Tier 2: Preferred Brand - brand name formulary drugs that have the lowest brand copay
- Tier 3: Non-Preferred Brand - brand name formulary drugs that are designated by us to be non-preferred brand
- Tier 4: Preferred Specialty Drugs - biologics or drugs that require close monitoring for safety and efficacy and as designated by us to be specialty drugs
- Tier 4A: Non-Preferred Specialty Drug - biologics or drugs that are designated by us to be non-preferred specialty drugs
- Preventive: Generic preventive prescription drugs - used to prevent illnesses, diseases or other health problems — that the Affordable Care Act requires us to cover without charging you a copay or other out-of-pocket costs.
- Medical drugs - drugs infused or administered in a doctor’s office or facility that are covered under your medical benefit. Some medical drugs are classified as specialty drugs, and we may require that they are obtained from a specialty pharmacy and co-insurance may apply. Home Infusion drugs are obtained from Home Infusion pharmacies. These are considered medical drugs and coinsurance may apply.
Home delivery service and specialty provider service
HAP offers home delivery pharmacy services through Pharmacy Advantage, our contracted mail order provider. You can get up to a 90-day supply of some medications (new prescriptions or a simple refill). This saves time and money and eliminates trips to the pharmacy.