Network Health Plan Preferred Drug List
A listing of the most commonly prescribed medications including co-payment tiers and restrictions, if any, on these medications. You will need Adobe Reader to view, use, and print this document. If you do not have this program installed on your computer, please use the link at the right of this screen to download Adobe Reader.
The Network Health Plan Preferred Drug List is a listing of the most commonly prescribed medications and their formulary status (for a complete list, visit the Express Scripts Member Website or call 1-800-417-3380). Use the Index section of this document to pinpoint the Chapter/Section/Subsection that your prescription medication is located under (for example, Lipitor 4.8.2). Using the menu on the left side of the screen, select the appropriate Chapter number, which is the first number in the group (in the case of Lipitor, the Chapter number is 4). Scroll down through the Chapter section to find your medication. Column headings are located at the top of each page, and list relative cost, drug name, restrictions for a given medication, and co-payment information.
Abbreviations are explained on the bottom of all odd pages.
If there is a "1" in the Tier column, you will pay your generic co-payment. If there is a "2" in the Tier column, you will pay your preferred brand co-payment. If there is a "3" in the Tier column, and you have a 3-tier benefit, you will pay your non-preferred brand co-payment. If you have a 2-tier benefit, you will not have access to these medications without authorization granted by Express Scripts on behalf of your health care provider. If a brand medication is requested when a generic is available, the appropriate co-payment plus the ancillary fee, or difference in cost between the brand medication and generic medication, will apply.
Please see the General Information section for additional information on this and other topics. Please be advised that this information is not a guarantee of coverage. Your co-payment and benefits will be determined when your pharmacy claim is submitted to Express Scripts.
