On the single-tier benefit, you have one co-payment for brand-name or generic drugs on the PDL. Prescription drugs that are not on the PDL are not covered unless prior approval is granted. Be certain to ask your doctor to prescribe a medication that is on the PDL whenever possible. Most Single-Tier Benefits have an ancillary fee for brand-name medications that have a generic available.


Two-Tier Benefit
There are two copayments available on the two-tier benefit. Generic drugs (first tier) on the PDL will always have the lowest copayment, and brand-name drugs (second tier) on the PDL have the higher copayment. If you are prescribed a brand-name drug that has a generic available, you can choose the lower copayment by opting for the generic drug. If you select a brand-name drug on the PDL, you will pay the higher copayment. Prescription drugs not on the PDL are not covered unless prior approval is granted. You can request that your doctor consider prescribing a medication that is on the PDL.

Three-tier Benefit
The three-tier benefit has three different copayment options. Generic medications on the PDL have the lowest copayment. If you are prescribed a brand-name drug that has a generic available, the generic must be dispensed to receive the lowest (first tier) copayment.
If you select a brand-name drug on the PDL, you will pay a higher copayment (second tier).
With a three-tier benefit, you have access to almost all FDA approved prescription drugs - even those not on the PDL. However, you will pay the highest copayment for any drugs not on the PDL (third tier).
When your doctor prescribes medications from the PDL, you receive the most value from your prescription drug benefit.

•Members can initiate the prior authorization request via email or phone but pertinent medical information required to process the request must be obtained by PHP from your Physicians office.