Getting to know your Prescription Drug List

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Getting to know your Prescription Drug List
Getting to know your Prescription Drug List
The Prescription Drug List (PDL) contains the most commonly
prescribed medications preferred by your plan sponsor for
their safety, cost and effectiveness. Drugs are listed by common
categories or classes and placed in tiers that represent the cost
you pay. This makes it easier for you and your doctor to find
other options to help you save money.
The PDL is more than a list of drugs. It provides valuable information to help you:
• Manage your drug costs
• Find other medication options
• Understand your pharmacy benefits
Getting to know your Prescription Drug List
How do I find my medication in the PDL?
The PDL offers a table of contents and an index of covered drugs to help you
easily find your medications.
• Use the table of contents in the front of the PDL to find your condition, or
• Search for your medication by name in the index at the back of the PDL.
How do I read the PDL?
Drug Requirements
Tier and Limits
Cardiovascular/Heart Disease:
High Blood Pressure
Drug Name
Amlodipine
Amlodipine/Benazepril
Atenolol
Atenolol/Chlorthalidone
Azor
Benazepril
Benazepril/HCTZ
Benicar
Benicar HCT
Bisoprolol
Bisoprolol/HCTZ
Bystolic
Carvedilol
Chlorthalidone
Clonidine Tab
Coreg CR
Diltiazem
Diltiazem Sr 24HR
Diovan
Diovan HCT
Doxazosin
Dutoprol
Edarbi
Edarbyclor
Enalapril
Exforge
Exforge HCT
Felodipine
1
1
1
1
2
1
1
2
2
1
1
2
1
1
1
3
1
1
2
3
1
2
3
3
1
2
2
1
QL
QL
QL, ST
Drug tiers provide a helpful
indicator for quickly
estimating a medication’s cost
QL, ST
QL, ST
QL
Brand name drugs are
displayed in bold; generics
are shown in plain type
QL, ST
QL, ST
QL, ST
QL
QL, ST
QL, ST
QL, ST
QL, ST
QL
This example is for illustrative purposes only and may not
reflect actual tiers or coverage for the listed medications.
OptumRx | optumrx.com
Drugs are grouped by the
conditions they treat
Pharmacy programs and drug
restrictions are identified and
provide additional coverage
details to help you understand
your medication options
How much will my medication cost?
After each drug name listed in the PDL, you will notice what is called a drug tier. The
drug tier indicates the amount you pay to fill a prescription, which is determined by
your employer or health plan. Generic medications typically cost less than brand name
drugs; however this may not always be the case. Refer to your benefit plan documents
or visit optumrx.com to find your specific costs.
Tier 1
Tier 2
Tier 3
Lowest-cost
medications
Mid-cost
medications
Highest-cost
medications
How can I save money on my prescriptions?
Changing from a higher-tier drug to a lower-tier drug may save you money. Check your
PDL and work with your doctor to see if there are drug options in Tier 1 that can treat
your condition.
What are “requirements and limits?”
The PDL provides information about programs and coverage details to help you make
informed decisions about your choice of prescription medications. Check your benefit
plan documents to find out what programs apply to your plan.
PA Prior Authorization
Your doctor needs to tell us why you
are taking a medication in order to
determine benefit coverage.
AR Age Restrictions
Some drugs are not safe for children
and the elderly. Age restrictions are
applied to these drugs to reduce the
risk of adverse effects.
ST Step Therapy
The step therapy program requires
that you try a lower-cost medication
before a higher-cost medication
is covered.
GR Gender Restrictions
Gender restrictions are applied to some
drugs that may not be safe or effective
depending on gender.
QL Quantity Limits
A quantity limit is the largest quantity
of medication covered per copayment
or in a defined period of time.
SP Specialty Medication
Specialty medications treat rare or
complex conditions and are typically
higher-cost medications.
How do I get updated information about my pharmacy benefit?
Since the PDL may change during your plan year, we encourage you to visit optumrx.com
and click on Formulary (also referred to as a prescription drug list) or call the toll-free
member phone number on the back of your ID card for more current information.
John Smith
John Smith
JOHN SMITH
When you register at optumrx.com, you can use the website’s helpful tools
and features to:
• L ook up the price of drugs covered by your plan
• F ind lower-cost options
•R
efill and renew mail service prescriptions
•V
iew your order status and claims history
• S ign up for text reminders to take and refill your medicine
•V
iew your benefits in real time
•O
rder medical supplies
• S hop for health and wellness products
optumrx.com
OptumRx specializes in the delivery, clinical management and affordability of prescription medications and consumer health
products. We are an OptumTM company — a leading provider of integrated health services. Learn more at optum.com.
All OptumTM trademarks and logos are owned by Optum, Inc. All other brand or product names are trademarks
or registered marks of their respective owners.
ORX7145_140107 ©2014 OptumRx, Inc.

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