Prescription Drugs

At Common Ground Healthcare Cooperative, we use medical evidence to determine which medications to cover that are most effective for our members. The list of covered medications, which is also called a “formulary,” covers different drug tiers. On most of our plans, different drug tiers have different copays. It’s just like shopping for anything else. Many times Tier 1 drugs (Generic brand) are cheaper than Tier 3 drugs (Preferred brand). Learn more in the first pages of our formulary.
To reference last year’s Formulary, click here.

 

Some drugs in our formulary note “PA” next to them, which means you need Prior Authorization to use them.

By using the buttons above, members can search for in-network pharmacies. The good news is that you can fill your prescription at most popular chain pharmacies because of our Wide Pharmacy network with OptumRx! Pharmacies like Walgreens, CVS, Walmart, Costco, Sam’s Club, Meijer, Kroeger, Pick N’ Save, and all of our provider partners’ pharmacies are all in-network options where your prescriptions can be filled. Using the online pharmacy network tool, you can find a pharmacy near you (and in your proximity based on zip code).

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If you want to be sure your pharmacy is in-network, call our Pharmacy Benefit Manager, OptumRx at 855.577.6545. OptumRx can also help members determine their financial responsibility for a drug, based on the pharmacy benefit, initiate the exceptions process, order a refill for an existing, unexpired mail-order prescription, and determine the availability or generic substitutes for medications. Use the OptumRx Prescription Reimbursement Request form to request reimbursement for covered medications purchased at retail cost.

Did you know?

 

CGHC plans offer 90 day fills of certain maintenance medications for only two co-pays. You can sign up for mail order by visiting the OptumRx portal or calling the number on the back of your ID card. Click here for frequently asked questions and more information.

pharmacist

Access to this formulary does not guarantee any coverage details or benefits available; it only provides access to view the full list of medications that are available through Common Ground Healthcare Cooperative’s Prescription Drug Formulary. For a complete outline of covered benefits and details on medication coverage, please refer to your policy and the Schedule of Benefits provided in your enrollment packet. Some medications listed on the Prescription Drug Formulary may not be covered under your specific benefit. Where differences are noted, the benefit plan documents will govern. We reserve the right to add or remove prescription drugs from the formulary as deemed necessary. If you have questions regarding your prescription drug coverage, please call Member Services at 877-514-2442.

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