2025 Prescription Drug Information
Common Ground Healthcare Cooperative (CGHC) uses a formulary which is a list of prescription drugs that are covered by your plan. You and your doctor can use the formulary to help you choose the most cost-effective covered prescription drugs.
The drug formulary is updated monthly, and drugs may be added, dropped, or moved from one drug price tier to another. We will post these formulary changes on our website monthly. We will also notify you when we know that a change to our formulary will adversely affect you. We encourage you to talk with your pharmacist about your medications. You deserve to get the best results from the prescriptions you take and save money too.
Within the formulary, medications are placed into cost levels known as tiers. The CGHC Formulary has up to six levels or tiers. 0 (Preventive), 1, 2, 3, 4, and CM (Oral Chemotherapy). In general, the higher the cost-sharing tier number, the higher the cost of the drug. The copay amount, if applicable, increases as the tier number increases. Likewise, when deductible and/or coinsurance apply, your out-of-pocket costs for a tier 4 drug will generally be the highest compared with the other tiers.
All deductibles, coinsurance and copay amounts a member pays will count toward their maximum out of-pocket amount.
Tier 0/ $0 Preventive:
Tier 0 preventive care drugs taken on a regular basis to help prevent the onset or recurrence of a disease or condition.
Tier 1 / $ Generic:
Use tier 1 generic drugs instead of brand name drugs to help reduce your out-of-pocket costs.
Tier 2 / $$ Preferred:
Use tier 2 preferred brand name drugs to help reduce out-of-pocket costs. They will generally have lower copayments than non-preferred brand name drugs.
Tier 3 / $$$ Non-preferred:
Many tier 3 drugs have lower cost options in tier 1 or 2. Ask your prescriber if the drugs in the lower tiers could work for you and help reduce your out-of-pocket costs.
Tier 4 / $$$$ Specialty:
These drugs are sometimes used for complex and chronic conditions and may require special monitoring and handling. They are generally highest in copayment and cost.
Tier CM Oral chemotherapy:
Drugs used for oral chemotherapy may have a designated copayment or coinsurance based on state laws or client preference.
If you see letters next to the drug, take note. These letters indicate the drug has coverage requirements or limits.
For example, the abbreviation “PA” is used in the drug formulary to show that a prior authorization is needed. CGHC may require health care providers (doctors or other licensed prescribers) to send us information about why a drug or a certain amount is needed. This is called a prior authorization request and must be approved before a member can get the drug.
Other letters are ST for Step Therapy and QL for quantity limits. Learn more about the requirements for drug coverage in the first pages of our formulary.
Use the buttons below to view the view the Formulary (Prescription Drug List) and the Pharmacy Network.
Visit Find My Prescriptions where you can:
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- Search for drugs and compare pricing options
- Locate pharmacies in your area by zip code
- Send medications directly to your home
- Determine the availability of generic substitutes
- Manage your medications and orders using any device
- Set reminders so you take your medications on time
- Get answers to commonly asked questions
- Submit your request for reimbursement for covered medications
- Receive guidance about your pharmacy benefits, such as how to:
- Determine your financial responsibility for a drug
- Initiate the exceptions process
- Handle unexpired mail-order prescription
The full features of Find My Prescriptions are accessible when you activate your Express Scripts account. The fastest way to do this is to log into your Member Health Portal, powered by CareSource®.
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- First time users should click on Sign Up and follow the on-screen prompts to activate. Once in the Member Health Portal, click on the Benefits tab and follow the onscreen prompts to access the Find My Prescriptions portal.
Limited features are available without activating an Express Scripts account, you can activate your account by clicking here.
Home Delivery (Mail Order) Medications – Express Scripts Pharmacy
CGHC works with Express Scripts Pharmacy to supply prescription medicines to a member’s home, workplace or doctor’s office. Using this service could change a member’s copay amount. Example: members can receive a 90-day supply of certain maintenance drugs for two copays. Express Scripts Pharmacy can help members to:
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- Get prescriptions filled
- Move a prescription to Express Scripts Pharmacy from another pharmacy
- Set up their account on express-scripts.com for billing and delivery of prescriptions
- For more information, call CGHC Member Services at877-514-2442. Our hours are Monday through Friday from 8 a.m. to 5 p.m. Central Time (CT)
- Members may also access the express-scripts.com website through the Member Health Portal. There you can manage prescription refills for specialty and mail order medications and check coverage. To create an account, go to Member Health Portal, powered by CareSource®.
Specialty Pharmacy – Accredo Pharmacy
CGHC works with Accredo Pharmacy to supply specialty medications that may be prescribed for members. Accredo Pharmacy can help members to:
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- Get prescriptions filled
- Move a prescription to Accredo Pharmacy from another pharmacy
- Deliver members’ specialty medicines to their homes, workplaces or their doctors’ offices
- Learn about their specialty medications and give them support from specially trained health care professionals
- For more information, call Accredo Pharmacy at 1-866-231-3520. Their hours are Monday through Friday from 7 a.m. to 10 p.m. Central Time (CT)
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