Prescription Benefits for you and your employees

Health Options group plans include prescription medication coverage. Here are some ways to find out what is covered, to what extent, and if there are cost-saving opportunities.

Get started:

Check the drug list

Health Options maintains a catalog of covered prescription drugs called a formulary. It lists the drugs in alphabetical order within treatment categories such as THERAPY FOR ACNE and TOPICAL ANTIBACTERIALS. It also distinguishes BRAND name drugs (shown in all capital letters) from generics (shown in lowercase italic letters). Any pre-requisites or restrictions are indicated in the Requirements/Limits column.

Click here to access the formulary.

Learn about Tiers

Covered medications are divided into the five levels, or Tiers, shown in the table below. A drug’s Tier is indicated in the formulary’s Tier Group column. Depending on your plan, some or all Tiers may have an associated out-of-pocket cost. These costs are explained in your Summary of Benefits and Coverage. You can ask your provider if a prescription is available from a lesser-cost Tier.

Tier 1  Preferred Generics
Tier 2  Generics
Tier 3  Preferred Brands
Tier 4  Non-preferred Brands
Tier 5  Specialty Medications

 

Take advantage of Express Scripts' online resources for convenience and cost savings

Health Options works closely with Express Scripts, a leading prescription benefit plan provider, whose online tools are available to you. Creating an Express Scripts account lets you access your prescription drug information via website and mobile app. You can then use your computer, tablet or cell phone to search for covered medications, locate a pharmacy, place mail order refill requests, price drugs and compare costs. All mail-order medications are eligible for the Extended Payment Program that splits the cost into three payments spaced 30 days apart.

To create a secure account, have your Member ID or social security number ready and go to https://express-scripts.com/.

Talk to Health Options' Care Management Team

Our Care Managers and Care Navigators may be able to suggest additional cost-savings opportunities that could include:

  • Switching to mail-order
  • Using manufacturer coupons or patient assistance programs
  • Changing dosage form (for example, from tablets to capsule)
  • Obtaining a cost-share reduction (available under certain circumstances)
  • Taking advantage of retailer discount programs

You can reach our Care Management Team by calling Member Services at (855) 624-6463. Health Options also proactively sends targeted information about potential cost-saving opportunities by phone call or mail.