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.

Pharmacy Network – use the button above to search for in-network pharmacies. The good news is that most popular chain are included!

 

OptumRX Website – click the button above to:

  • Locate pharmacies in your area by zip code
  • Send medications directly to your home
  • Determine the availability of generic substitutes
  • Search for drugs and compare pricing options
  • Manage your medications and orders using any device
  • Set reminders so you take your medications on time
  • Get answers to commonly asked questions
  • Use the OptumRx Prescription Reimbursement Request form to request reimbursement for covered medications purchased at retail cost.
  • 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

 

Preventive Drug List – Use the button above to see the preventive care medications and products that are covered at 100% with $0 cost-share.

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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