Pharmacy Benefits
Our pharmacy benefits program is designed to help you get the medications you need while controlling cost.
Whether you’re getting medications from your local pharmacy or having it delivered to your door, we offer flexible options to fit your lifestyle.
Pharmacy Benefits
Our pharmacy benefits program is designed to help you get the medications you need while controlling cost.
Whether you’re getting medications from your local pharmacy or having them delivered to your door, we offer flexible options to fit your lifestyle.
Here’s what you can expect:
- Access to a wide network of retail and mail-order pharmacies available through the Pharmacy Locator Tool
- Coverage for generic and brand-name medications on the preferred drug list (PDL)
- Cost-saving tools: Formulary Lookup, PDL generic alternatives, cost comparisons between pharmacies and more
- Convenient mail-order delivery options
- Support available from customer service team 24/7
Explore your pharmacy benefits, find participating pharmacies, and learn how to make the most of your coverage — all in one place. Go to www.medimpact.com to register with MedImpact, our Pharmacy Benefit Manager, or download their mobile app.
Preferred Drug List
A Preferred Drug List (PDL) is the list of medications that are Food and Drug Administration (FDA) approved and covered by your health plan. It is also known as a
drug formulary. It’s an important part of a health plan’s duty to make sure you get quality medications that support your health needs.
22 Health’s PDL is designed to help your provider choose medications that are clinically effective and cost-efficient. The amount you pay depends on the medication chosen by your doctor and its tier level. The goal is to provide you with access to safe, effective, and affordable drugs.
Your co-pay may be as low as $0.00, depending on your prescription, its drug tier, and your health plan benefits. Preferred generic drugs usually cost less than preferred brand drugs. Medications that are not on the list are considered non-preferred.
How Medications are Organized
Medications on the PDL are typically grouped into tiers based on their cost:
- Tier 1: Most affordable, usually generic drugs
- Tier 2: Preferred brand-name drugs
- Tier 3: Non-preferred brand-name drugs
- Tier 4: Specialty drugs, often high-cost medications
Tier 5: High-cost specialty drugs with limited pharmacy access
Creating medication tiers lets you and your provider determine your out-of-pocket costs in advance and potentially provides a less expensive option for you to consider before getting your medicines from the pharmacy. Generally, drugs in lower tiers have lower copays or coinsurance.
How to Use the PDL
Search for medications: Use the online formulary or online formulary look-up tool to find specific medications and determine if they are covered by your health plan.
Review tiers: Check the tier of your prescribed medication to learn about your potential out-of-pocket costs.
Ask your healthcare provider: Ask your provider or pharmacist about other medications that may be more affordable.
Prior authorizations/limitations: Some medications on the PDL require authorization from your health plan. Other medications may have quantity or age-related limits. These processes ensure safe and effective use of the medications you may be prescribed.
Your Health Plan’s PDL Updates
22 Health’s PDL will be updated during the first week of January, April, July, and October. As part of those updates, medications that are no longer effective or
cost-efficient will be added and removed. If you are using a medication that is being removed from the PDL, we will notify you and the provider who prescribed
the medicine in advance and provide guidance on alternative options.
Need Help?
For prescription or medication help, please call MedImpact at 1-888-807-5695.
Need Help?
If you have questions about the PDL or need help finding medications, please contact Member Services at 1-866-357-4082. This number is also listed on your 22 Health member identification card.