The Prevea360 drug listing (also called a formulary) is reviewed every month. We make regular changes and updates as new generic products are approved. Our formulary lists medications by copay tier. Lower tiers are associated with lower cost share. In addition to updating the formulary status of covered drugs, we also modify formulary restrictions as necessary.
Here's an update of restrictions and limitations associated with our drug formulary:
A pharmacy and therapeutics committee makes all drug therapy decisions, including step therapy. They evaluate the safety and efficacy of a product, including clinical practice guidelines, based on available medical literature.
Priority is put on current U.S. guidelines that:
When higher-quality guidelines are unavailable, we consider others which:
The committee considers cost only after it makes the clinical determination. Once the medication is evaluated, if a lower cost alternative exists, a step therapy protocol is set up.