Prescription Drugs

Prescription Drugs Covered by Health Tradition

Prescription drugs covered by Health Tradition are listed in the Health Tradition Formulary. These are drugs selected for their proven effectiveness, safety and reasonable cost. The formulary is actively managed by Health Tradition and MedImpact. It 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.

The Health Tradition Formulary

The formulary is a list of prescription drugs covered by a health plan, showing the cost-sharing categories for each of four drug types.

• Generic. Less expensive than brand name
• Brand name. Often newer and more expensive than generic
• Non-formulary. Drugs not in the Health Tradition formulary which may have coverage depending on the plan
• Specialty drugs. Drugs used to treat complex or chronic conditions, including self-administered injectables

Medications that Require Prior Authorization

Medications requiring prior authorization are noted in the Health Tradition Formulary.

For a list of exclusions in addition to the Complete Formulary, please reference Health Tradition Drug Exclusions.

Please note:

• We do not cover any drug that has not been approved by the FDA for at least one (1) year for the purpose that your healthcare provider is prescribing it or it is otherwise being used.
• We do not cover any weight loss medication.
• We do not cover any infertility medication.

Our Customer Service Team can help with questions on whether 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 of a drug is provided, a drug that requires prior authorization would be approved as a 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.