Drug Plan Information for Members

Filling prescriptions

For covered prescription drugs, you pay a single copayment (or coinsurance percentage) for up to a 30-day supply. Coverage for various types of drugs is shown in your Summary of Benefits and Coverage (SBC). Log in to MaddyPortal.com to view your SBC.

Discuss options with your doctor and save money

Generic drugs generally cost less, so ask your doctor if there is a generic alternative. If you choose a brand-name drug when a generic equivalent is available, you would pay the generic copayment plus the difference in price between the brand name and the generic drug.

Prices can vary widely from one pharmacy to another. It pays to shop, especially if you are on a maintenance (long term) medication. Mail order is often a good option.

Coordination of benefits

For members who have dual (two or more) insurance policies, Health Tradition does offer coordination of benefits for prescriptions.

Additional drugs may be covered

Health Tradition has an open formulary, which allows non-formulary drugs to be covered. If a drug is not on the formulary or isn’t covered under your plan, you may 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 or call Customer Service.

Certain medications require prior authorization

Medications requiring prior authorization are highlighted in the Health Tradition Formulary. You may also call Customer Service to ask if a medication requires prior authorization. Practitioners are responsible for submitting prior authorization requests.

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. Check with Customer Service for answers to specific questions.