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.