The drug search may list a single drug or a list of drugs. The search will tell
you how the drug is covered in our plan; as well as other plan information you should
know about the drug.
Tier Explanation
Each drug will indicate one of the following indicators.
Please Note: All drugs in both Tiers 1 and 2 are covered in the gap for our
ADVANTAGE Select (PPO),
ADVANTAGE Choice (PPO),
ADVANTAGE Enhanced (PPO),
ADVANTAGE Elite (PPO),
ADVANTAGE Community Health Network (HMO),
ADVANTAGE St. Francis Health Network (HMO),
and ADVANTAGE Wishard Network (HMO)
plans. Please refer to your Evidence of Coverage
or Summary of Benefits for cost-sharing information on each tier level.
|
Indicator |
Description |
|
1 |
Preferred Generic Drug |
|
2 |
Non-Preferred Generic Drug |
|
3 |
Preferred Brand Name Drug |
|
4 |
Non-Preferred Brand Name Drug |
|
5 |
Specialty Drug |
|
NF |
Non-Formulary Drug. This drug is not on our plan formulary. If you click on “NF”,
the system will display a listing of those agents which are similar in use, or function
that are available as covered medications. This is not a complete list of all formulary
alternatives covered by ADVANTAGE Health Solutions for the drug you have selected.
|
Note Explanation
Some drugs in your search results will have an indicator in the Notes section. Please
refer to the table below to help explain what this indicator represents.
|
Indicator |
Description |
|
PA |
Prior Authorization Required. If you click on “PA”, the system will display a popup
window which will provide you further information regarding the prior authorization
requirements. |
|
SP |
Limited Access Drugs. This medication may only be available from certain pharmacies. |
|
ST |
Step Therapy Required. If you click on “ST”, the system will display a popup window
which will provide you further information regarding the step therapy requirements. |
|
QL |
Quality Limit Restriction. If you click on the “QL”, the system will display a popup
window which will provide you further information regarding the quality limit restriction.
|
Please Note: All formulary drugs are available via our mail-order.