Your prescription drug benefit
How the prescription benefit works
You pay a single copayment (or coinsurance) for up to a 30-day supply. You may receive a generic drug, or a brand name drug without a generic equivalent, for a single copayment. The generic copayment is generally a lower amount than the brand name copayment. If you receive a brand name drug when a generic equivalent is available, you pay the generic copayment plus the difference in price between the brand name and generic drug.
Health Tradition encourages you to discuss your prescription options with your healthcare provider. Please refer to your Summary of Benefits, found under Plan documents, for your copayment amounts.
Your pharmacy network
Health Tradition has contracted with MedImpact to provide you with a national network of pharmacies. You can access the MedImpact costing and the participating pharmacy tool here. Fill prescriptions conveniently in your community, or across the country, for the same copayment amount. Simply present your membership card to your pharmacist to verify whether the pharmacy participates in the MedImpact network.
If you have additional questions about whether a specific pharmacy is in the network, please call our Customer Service team toll free at 877.832.1832.
The prescription drug formulary
A formulary is a list of drugs covered by a health plan. The Health Tradition Formulary is Health Tradition’s own formulary. It includes drugs selected for their proven effectiveness, safety and reasonable cost. The formulary is updated throughout the year to incorporate the latest research, respond to price changes and shortages faster, and add newer, more effective drugs sooner. Health Tradition reserves the right to change the formulary at any time.
Health Tradition has an open formulary, which allows non-formulary drugs to be covered. If a drug is not listed on the formulary or not covered under your plan, you either will be responsible for the larger non-formulary copayment or the entire cost of the medication, depending on your plan. Please review your Summary of Benefits and Coverage.
Certain medications require prior authorization
Medications requiring prior authorization are noted in the Health Tradition Formulary.
You may also call Customer Service at 877.832.1823 to ask if a medication requires prior authorization. Practitioners are responsible for submitting prior authorizations.
For prescriptions requiring prior authorization, the standard authorization time is 72 business hours. Expedited reviews will be processed in 24 hours. When documentation of prior use is provided, a drug which requires prior authorization would be approved as continuation of therapy.
Foreign travel and vacations
Coverage is limited and restrictions apply. Reimbursement for prescriptions purchased outside the United States is subject to approved status with the United States Food and Drug Administration.
Coordination of benefits
For members who have dual (two or more) insurance policies, Health Tradition does offer coordination of benefit for prescriptions.
- Understanding your Prescription Drug Plan
- Health Tradition Health Plan Specialty Drug Requirement
- For questions or more information on your pharmacy benefits, please contact Customer Service toll free at 1-877-832-1823.