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How the Plan Works

Deductible/Copayment Three-Tier Drug Program

When a drug is prescribed, members should remind their doctor that they are covered by the Deductible/Copayment Three-Tier Drug Program and review the Formulary Guide with their doctor. Here’s how the program works:

Your doctor needs to give you a prescription for medication:
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Your prescription is a formulary drug. You give your doctor your formulary listing and ask him/her to prescribe you a drug from the Select Drug Program rormulary, if possible. (Your cost-sharing will be less if the drug is on the formulary.) Your prescription is NOT on the formulary.
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Your doctor reviews the formulary and decides that a drug on the formulary can treat your condition. He gives you a prescription for your medication. (If you are taking a maintenance medication, you may obtain a second prescription for your 90-day refill through mail-order.)
 Your doctor reviews the formulary and decides a covered non-formulary drug fits your needs better and writes you a prescription. (If you are taking a maintenance medication, you may obtain a second prescription for your 90-day refill through mail-order.)
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You take your prescription to your local participating FutureScripts® pharmacy.* Your pharmacist fills your prescription and charges you the lower generic or brand formulary copayment.
 You take your prescription to your local FutureScripts participating pharmacy.* Your pharmacist fills your prescription and charges you the higher non-formulary brand copayment.

If this drug is a maintenance medication, you may send your second prescription to our mail-order pharmacy, to receive your next 90-day supply. You will pay two times the generic or brand formulary copayment for a formulary drug or two times the higher non-formulary brand copayment for a covered non-formulary drug.

OR

Simply return to your pharmacy if a refill is indicated. You will pay the generic or brand formulary copayment for a formulary drug or the higher non-formulary brand copayment for a covered non-formulary drug. You can receive up to a 90-day supply of your medication at a retail pharmacy. Contact AmeriHealth at 1-888-671-5280 to learn more.

* FutureScripts is an independent company and serves as AmeriHealth’s pharmacy benefits manager.

Select Drug Program® Formulary

The links and documents in the Select Drug Program formulary apply to this program.

Go to Find a Formulary Drug.