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It defines a formulary and formulary tiers, describes how brand and generic drugs differ, and outlines how costs and coverage can change during the year. Guidance covers exclusions, specialty and over-the-counter options, prior authorization and quantity limits, and how to request a coverage review for excluded medications. It also clarifies how to read drug list symbols and tier information to support cost-effective treatment decisions.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/2024-premium-standard-formulary-effective-january-1-2024/403046/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/2024-premium-standard-formulary-effective-january-1-2024/403046.png","ImageObject",300,407,{"name":92,"@type":93},"Ophelia","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-29","2026-09-27",true,{"@type":102,"interactionType":103,"userInteractionCount":39},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What is a formulary and how is it organized?","Question",{"text":112,"@type":113},"A formulary is a list of prescribed medications and other pharmacy care products, services, or supplies chosen for safety, cost, and effectiveness. Medications are listed by categories or classes and placed into cost tiers.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How do tiers work and when can medications move between tiers?",{"text":117,"@type":113},"Tiers are different cost levels for medications, with assigned costs set by an employer or plan sponsor. Medications may move to a lower tier at any time, move to a higher tier when a generic becomes available, and may be moved to a higher tier or excluded on January 1 or July 1 each year.",{"name":119,"@type":110,"acceptedAnswer":120},"Why might a medication be excluded from coverage, and what can be done?",{"text":121,"@type":113},"A medication may be excluded if it works the same as or is similar to another prescription or over-the-counter (OTC) medication. If you disagree with an excluded medication decision, you, an authorized representative, or your doctor can request coverage by calling the number on your member ID card.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},403046,1791081314,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":39,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},7971461741311,"https://ap-avatar.wpscdn.com/avatar/74000253aff267980c6?x-image-process=image/resize,m_fixed,w_180,h_180&k=1779345379180704826","2024 Premium Standard Formulary  \nEffective January 1, 2024  \nFor the most current list of covered medications or if you have questions:  \nCall the number on your member ID card.  \nVisit your plan’s website on your member ID card or log on to the Optum Rx app to:  \n• Find a participating retail pharmacy by ZIP code.  \n• Look up possible lower-cost medication alternatives.  \n• Compare medication pricing and options.  \nUnderstanding your formulary  \nWhatis a formulary?  \nA formulary is a list of prescribed medications or other pharmacy care products, services or supplies chosen for their safety, cost, and effectiveness. Medications are listed by categories or classes and are placed into cost levels known as tiers. It includes both brand and generic prescription medications.  \nTo create the list, Optum Rx® is guided by the Pharmacy and Therapeutics Committee. This group of doctors and pharmacists reviews which medications will be covered, how well the drugs work, and overall value. They also make sure  \nthere are safe and covered options.  \nHow doI use my formulary?  \nYou and your doctor can use the formulary to help you choose the most cost-effective prescription medications. This guide tells you if a medication is generic or brand, and if special rules apply. If your medication is not listed here, please visit your plan’s website or call the number on your member ID card.  \nWhat are tiers?  \nTiers are the different cost levels you pay for a medication. Each tier is assigned a cost, set by your employer or plan sponsor.  \nWhen does the formulary change?  \n• Medications may move to a lower tier at anytime.  \n• Medications may move to a higher tier when a generic equal becomes available.  \n• Medications may move to a higher tier or be excluded from coverage on January 1 or July 1 of each year.  \nAbout this formulary  \nWhere differences exist between this list and your benefit plan, the benefit plan documents rule. This is not a complete list of your covered medications. Please review your benefit plan documents for full details. Not all formulary alternatives listed in this document may be appropriate foryour specific condition. Please talk to your doctor.  \nIf a medication changes tiers, you may have to pay a different amount for that medication.  \nWhy are some medications excluded from coverage?  \nA medication may be excluded from coverage under your pharmacy benefit when it works the same as or is similar to another prescription or over-the-counter (OTC) medication.  \nWhat if I don’tagree with a decision about an excluded medication?  \nYou, your authorized representative, or your doctor can ask for a coverage request by calling the number on your member ID card.  \nMedication tips  \nWhat is the difference between brand-name and generic medications?  \nGeneric medications contain the same active ingredients (offer the same effect) as brand-name medications, but they often cost less. Once the patent for a brand-name medication ends, the FDA can approve a generic version with the same active ingredients.  \nWhat if my doctor writes a brand-name prescription?  \nIf your doctor gives you a prescription for a brand-name medication, ask if a generic or lower-cost option could be right for you. Generic medications are usually your lowest-cost option.  \nWhat if I am taking a specialty medication?  \nSpecialty medications are used to treat complex conditions. These high-cost medications may be injected, infused or taken by mouth. Please note, not all specialty medications are listed in the formulary. Our  \nspecialty pharmacy can provide most of your specialty medications along with helpful programs and services.  \nOver-the-counter medications (OTC)  \nTalk to your doctor about OTC options. Even though OTC medications may not be covered by your pharmacy benefit, they may cost less than a prescription medication.  \nReading your formulary  \nThe formulary gives you choices so you and your doctor can decide your best course of treatment. In this fo","cbCaiqVFaDuIqO0r","https://ap.wps.com/l/cbCaiqVFaDuIqO0r","pdf",1457678,64,"English","# Understanding your formulary\n## What is a formulary?\n## How do I use my formulary?\n## What are tiers?\n## When does the formulary change?\n## About this formulary\n## Why are some medications excluded from coverage?\n## What if I don’t agree with a decision about an excluded medication?\n# Medication tips\n## Difference between brand-name and generic medications\n## What if my doctor writes a brand-name prescription?\n## What if I am taking a specialty medication?\n## Over-the-counter medications (OTC)\n# Reading your formulary\n## Tier information\n## Drug list information","[{\"question\":\"What is a formulary and how is it organized?\",\"answer\":\"A formulary is a list of prescribed medications and other pharmacy care products, services, or supplies chosen for safety, cost, and effectiveness. Medications are listed by categories or classes and placed into cost tiers.\"},{\"question\":\"How do tiers work and when can medications move between tiers?\",\"answer\":\"Tiers are different cost levels for medications, with assigned costs set by an employer or plan sponsor. Medications may move to a lower tier at any time, move to a higher tier when a generic becomes available, and may be moved to a higher tier or excluded on January 1 or July 1 each year.\"},{\"question\":\"Why might a medication be excluded from coverage, and what can be done?\",\"answer\":\"A medication may be excluded if it works the same as or is similar to another prescription or over-the-counter (OTC) medication. If you disagree with an excluded medication decision, you, an authorized representative, or your doctor can request coverage by calling the number on your member ID card.\"}]","2024 Premium Standard Formulary - Effective January 1, 2024 | PDF",1790536836,161]