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ABOUT PHARMACY COVERAGE
- MedImpact is the prescription drug provider for all medical Plans.
- All prescriptions must be filled at an in-Network pharmacy by presenting your medical insurance card.
- Your pharmacy coverage is included in your medical coverage.
- Pharmacy contact information is found on the back of all medical provider ID cards.
- MEDIMPACT PHARMACY: 888-648-6769 | Rx BIN: 003585 | Rx PCN: 28914 | medimpact.com/plan/adoa/ | Generic Login to Preview Formulary - Username: EPOADOA3, Password: [email protected]
- MEDIMPACT SPECIALTY DIRECT PHARMACY: 877-391-1103
- MEDIMPACT DIRECT MAIL: 855-873-8739
MEDIMPACT PHARMACY MEMBER PORTAL
Real-time access to personalized healthcare and ﬁnancial information so you can better manage your budget and your healthcare.
- Benefit Highlights – View your copay amounts and other pharmacy benefit information.
- Prior Authorization Status – View the status of your prior authorization requests
- Remaining re-fills and expiration dates
- Complete prior authorization history
- Drug Price Check – Make informed drug choices and compare drug prices.
- Drug Information – Search drugs, check drug interactions, identify pills.
- PersonalHealth Rx® – Print your drug history for a physician visit or tax reporting.
- Pharmacy Locator – Find a participating network pharmacy near you, including preferred pharmacies that may have better pricing for your plan benefits, 24-hour pharmacies, and e-prescribing participants.
- Registration Required – For access to the tools, you need to manage your pharmacy beneﬁt. Please note that you will need to re-register if you have changed medical carriers.
The formulary is the list of medications chosen by a committee of doctors and pharmacists to help you maximize the value of your prescription benefit. These generic and brand-name medications are available at a lower cost. The use of non-preferred medications will result in a higher copay. Sharing the formulary with your doctor helps ensure you are getting the best value, saving money for you and the State of Arizona.
Changes to the formulary can occur during the Plan Year on a quarterly basis. Medications that no longer offer the best therapeutic value for the Plan are removed from the formulary. Ask your pharmacist to verify the current cost or copay amount when your prescription is filled. Members can log into the MedImpact Pharmacy website for complete formulary information.
Preferred Drug List
|The Preferred Drug List (PDL) lists commonly prescribed medications within select classes of drugs covered on your formulary. The formulary is updated regularly and is subject to change without advance notice.|
Specialty Drug List
Certain medications used for treating chronic or complex health conditions are handled through the MedImpact Program. This program assists you with monitoring your medication needs and provides patient education. The program includes monitoring of specific injection drugs and other therapies requiring complex administration methods and special storage, handling, and delivery. The formulary is updated regularly and is subject to change without advance notice.
Specialty medications are limited to a 31-day supply and may be obtained only at a participating retail pharmacy or through the MedImpact Specialty Pharmacy. Members may enroll in services by calling 877-391-1103 (TTY dial 711) or email us at [email protected].
Essential Health Benefits List
|Under the Affordable Care Act, certain preventive medications are covered at zero-copay under the pharmacy benefit as needed in compliance with healthcare reform requirements under the Affordable Care Act. State-specific requirements may vary.|
|Preventive Drugs are prescribed for people at risk for certain diseases but do not yet show signs and symptoms. They are used to prevent a disease or condition, a complication from a disease, or prevent a recurrence of a condition. They are typically not used to treat an existing illness.|
You will not pay the full cost of these drugs, and the copays will not accumulate to meet the HSA deductible. Only the normal flat dollar copay will apply to these drugs, as shown under Copays below.
GUIDELINES & LIMITS
Some drugs may have additional requirements or limits on coverage. These requirements may include:
- Prior Authorization - Prescriptions for certain medications may require clinical approval before they can be filled, even with a valid prescription. These prescriptions may be limited to quantity, frequency, dosage or may have age restrictions. You, your local pharmacy, or your physician may initiate the authorization process by contacting MedImpact. Learn more about Prior Authorization, including processing times, in this flyer.
- Step Therapy Program - The program promotes the use of safe, cost-effective, and clinically appropriate medications. This requirement encourages you to try less costly but just as effective drugs before the Plan covers another drug. For example, if Drug A and Drug B treat the same medical condition, the Plan may require you to try Drug A first. If Drug A does not work for you, the Plan will then cover Drug B. This requirement to try a different drug first is called “step therapy.” Learn more about Step Therapy in this flyer.
- Quantity Limits - For certain drugs, there are limits on the amount of the drug that will be covered.
- Coordination of Benefits - Benefit Options does not coordinate pharmacy benefits.
- Out-of-Network & International - The cost of prescriptions filled out-of-Network will not be reimbursed. No international pharmacy services are covered. Fill prescriptions before your trip and take your prescriptions with you. No coverage for a medication that is lost, stolen, or damaged.
CONTROLLING YOUR COSTS
MAIL ORDER PHARMACY
Save money with mail order - receive a three-month supply for the price of a two-month supply.
CHOICE 90 Rx
Save time and money at the pharmacy - in just one visit, pick up a full three-month supply for the price of two-and-a-half copays.
iRx DISCOUNT PROGRAM
- The iRx Program™ may be able to provide a discount on certain brand and generic medications that are not covered by your ADOA pharmacy drug plan.
- Present your medical ID card at any participating pharmacy, along with your prescription for the medication.
- Savings are applied automatically when the item prescribed qualifies for a discount.
GENERIC vs. BRAND NAME DRUGS
Learn the key information about each type of drug in this flyer.
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| ||Generic||Preferred Brand Name||Non-Preferred Brand Name|
|Retail 31-Day Supply||$15||$40||$60|
|Retail 90-Day Supply||$37.50||$100||$150|
Mail Order 90-Day Supply
MedImpact Direct Specialty Pharmacy
MedImpact Direct Mail