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It outlines how members and doctors can use the formulary to choose cost-effective prescriptions, why certain medications may be excluded, and how tier changes and coverage rules may affect out-of-pocket costs. 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Medications are grouped by categories or classes and placed into cost levels called tiers.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How can I use the formulary to choose a lower-cost medication?",{"text":117,"@type":113},"You and your doctor can use the formulary to select the most cost-effective prescription medications. The guide indicates whether a medication is generic or brand and whether special rules apply, including possible lower-cost alternatives.",{"name":119,"@type":110,"acceptedAnswer":120},"Why might a medication be excluded from coverage, and what happens if coverage is denied?",{"text":121,"@type":113},"A medication may be excluded when it works the same as or is similar to another prescription or OTC medication. If a request for coverage is not approved, you may need to pay the full cost of the prescription.","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},403047,1790653267,{"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},962084925636,"https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","2025  \nPremium Standard Formulary  \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.  \nEffective July 1, 2025  \nUnderstanding your formulary  \nWhat is 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 areplaced 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 there are safe and covered options.  \nHow do I 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 any time.  \n• Medications may move to a higher tier when a generic equal becomes available.  \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  \nthis document may be appropriate for your specific condition. Please talk to your doctor.  \n• Medications may move to a higher tier or be excluded from coverage on January 1 or July 1 of each year. If 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 my doctor wants me to keep taking my excluded medication?  \nYou, your authorized representative, or your doctor can start a request for coverage by calling the number on your member ID card. Your doctor will need to submit information for the review. If approved, you may keep filling your prescription for the excluded medication, but you may pay a higher cost. If not approved, you may pay the full cost of the prescription.  \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. In some situations, brand-name medications could be lower in cost.  \nWhat if my doctor writes a brand-name prescription?  \nIf your doctor gives you a prescription for a brand-name medication, ask if a lower-cost option could be right for you.  \nWhat if I am taking a specialty medication?  \nSpecialty medications are used to treat complex conditions and are generally higher in cost. Please note, not all specialty  \nOver-the-counter medications (OTC)  \nTalk to your doctor about OTC options. Even though  \nOTC medications may not be covered by your pharmacy benefit, they may cost less than a prescription medication.  \nmedications are listed in the formulary. Call the number on the back of your member ID card to learn more about where you can fill your specialty prescriptions.  \nReading your formulary  \nThe formulary gives yo","cbCaikqRtFT7Gj07","https://ap.wps.com/l/cbCaikqRtFT7Gj07","pdf",1353853,63,"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## Differences with the benefit plan\n## Coverage changes and excluded medications\n# Why are some medications excluded?\n# What if my doctor wants me to keep taking an excluded medication?\n# Medication tips\n## Brand-name vs generic medications\n## Brand-name prescriptions\n## Specialty medications\n# Over-the-counter (OTC)\n# Reading your formulary\n## Brand vs generic display formatting\n# Tier information\n# Drug list information and symbols\n## PA, QL, SP, ST, 3P, and ++","[{\"question\":\"What is a formulary and how are medications organized?\",\"answer\":\"A formulary is a list of prescribed medications and pharmacy care products, services, or supplies selected for safety, cost, and effectiveness. Medications are grouped by categories or classes and placed into cost levels called tiers.\"},{\"question\":\"How can I use the formulary to choose a lower-cost medication?\",\"answer\":\"You and your doctor can use the formulary to select the most cost-effective prescription medications. The guide indicates whether a medication is generic or brand and whether special rules apply, including possible lower-cost alternatives.\"},{\"question\":\"Why might a medication be excluded from coverage, and what happens if coverage is denied?\",\"answer\":\"A medication may be excluded when it works the same as or is similar to another prescription or OTC medication. If a request for coverage is not approved, you may need to pay the full cost of the prescription.\"}]","Premium Standard Formulary - Effective July 1, 2025 - Understanding your formulary | PDF",1790536840,159]