Using your prescription coverage
Your employer group may offer prescription coverage through HAP. To make sure you get quality medications, HAP uses a drug formulary. A formulary is a list of covered drugs and their respective copay tier, selected by HAP in consultation with a team of health care providers. Some employers also offer tiered prescription drug riders, which include different cost-sharing depending on the medications.
How much is covered?
HAP uses a tiered prescription cost-sharing system. Refer to the Summary of Benefits and Coverage (SBC) for plan-specific cost-sharing information. Generic medications usually have the smallest cost-sharing amount. An example of a four tiered plan is below:
- Tier 1 - Generic Rx: most generic covered prescription drugs
- Tier 2 - Preferred Rx: select brand prescription drugs
- Tier 3 - Non Preferred Rx: brand prescription drugs with lower cost alternatives
- Tier 4 - Specialty drugs
If an FDA-approved generic drug is available, your pharmacy will use the generic form of the medication.
The standard one month supply of a prescription drug is up to a 30-day supply. Specialty drugs, injectable drugs (except insulin) and select oral drugs (e.g. opioid analgesics) are limited to a maximum 30-day supply per fill. Some specialty drugs require a 15-day first fill.
HAP offers mail-order pharmacy services through Pharmacy Advantage, our contracted Specialty provider. You can get up to a 90-day supply of some medications (new prescriptions or a simple refill). This saves time and money, plus it eliminates trips to the pharmacy. If you need specialty drugs, those are required to be filled from Pharmacy Advantage.
While HAP covers a wide range of prescription medications, there are some exclusions, including:
- Over-the-counter (OTC) medications
- Medications for cosmetic purposes
- Experimental or medication products used in an experimental manner
- Replacement of lost or stolen medication
Medication coverage varies by employer, so check the subscriber contract and rider to verify your specific cost-sharing amounts and any applicable exclusions.