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2025 Prescription Drug Information

The list of covered medications is called a “formulary.”

It includes both brand name and generic drugs. Our pharmacy partners CareSource RxInnovations and Express Scripts create the list of covered drugs with guidance from the doctors and pharmacists from their Pharmacy and Therapeutics Committee who review clinical evidence about the safety and effectiveness of covered prescription drugs in our formulary. You and your doctor can use the formulary to help you choose the most cost-effective covered prescription drugs.

If you see letters next to the drug, take note. These letters indicate the drug has coverage requirements or limits. For example, PA means the prescription requires prior authorization. Your doctor needs to submit a drug authorization request.  Written PA approval needs to be received before the drug will be covered by your plan. 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.

Tier 0/ $0 Preventive:

Tier 0 drugs are preventive drugs that have no out-of-pocket costs

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.

Click here for 2024 Pharmacy information 
Access to the  formulary does not guarantee any coverage. It only shows the full list of medications that are available through CGHC’s Prescription Drug Formulary. For complete details on the benefits, limitations, and exclusions of your policy, please read the Certificate of Coverage available on our website or in My Health Portal. Some medications listed on the formulary may not be covered under your specific benefit. Where differences are noted, the Certificate of Coverage and Schedule of Benefits will govern. We reserve the right to add or remove prescription drugs from the formulary as needed. If you have questions regarding your coverage, please call Member Services at 877.514.2442.