Our pharmacy benefits give you the highest-quality meds at prices that won’t empty your bank account.
All About Your Meds
Whether they’re for strep throat or part of your disease management plan, medicines help keep you healthy and active.
Where can I fill my meds?For your meds to be covered, you must fill your prescription at a partner (in-network) Health Alliance pharmacy. The good news is they’re easy to find. Around almost every corner, you’ll see one.
- CVS (Consumer Value Stores)
- Doc’s Drugs Ltd.
- Dominick’s Finer Foods Inc.
- Fagen Pharmacy
- Horizon Pharmacy
- Hy-Vee Foods
- Kmart Corporation
- Medicine Shoppe
- Nash Finch Company
- NCS Healthcare Inc.
- Revco Discount Drug Centers
- Rite Aid
- Schnucks Markets Inc.
- ShopKo Stores Inc.
Many small, independent pharmacies are also in our network—too many to list. To see if your pharmacy is in our network, call our Pharmacy Department at 1-800-851-3379, option 4, Monday through Friday, 8 a.m. to 5 p.m. Also, check out our Preferred pharmacies. They can save you money on every refill.
What are tiers?
Our pharmacy plans work on a tier-system—think of “tiers” as steps. For low “steps” (or tiers), you pay the lowest copayment. As you take a step up, what you pay will increase.
Before filling a prescription, it’s smart to check the Health Alliance Drug Formulary. The formulary lists the most commonly prescribed meds Health Alliance covers and their tiers. We don’t list all drugs. If you don’t see your med, call our Pharmacy Department at 1-800-851-3379, option 4, Monday through Friday, 8 a.m. to 5 p.m.
What is a formulary?
The drug formulary organizes medicines into groups by drug class (meaning they work in a similar way) or medical condition. The meds on this list, both generic and brand-name, are the most commonly prescribed and the most cost-effective for members. Our Pharmacy Department and doctors decide what drugs to include based on quality, safety and how well they work (effectiveness).
If you’re not a member, we’re happy to help you find out how your meds are covered. Call us at 1-888-382-9771, Monday through Friday, 8 a.m. to 5 p.m. You can also take a look at our standard formulary*. Depending on your plan though, your formulary may be different.
Remember, Health Alliance members have quick access to their formulary by logging in at YourHealthAlliance.org.
Specialty drugs help members deal with complex diseases like cancer, rheumatoid arthritis and multiple sclerosis.
You might be asking, “Why are they so special?” We can answer that.
- Doctors must request preauthorization from Health Alliance for most specialty drugs. This is to make sure you meet the “special” criteria for getting the specialty drug covered.
- Doctors must also closely watch how specialty drugs are handled, stored and given—orally, injected or by IV—either at a health care facility or at home.
- Sometimes only “special” pharmacies carry specialty drugs. Check out our partnership with CVS Caremark Specialty Pharmacy.
See a list of what we consider specialty drugs.
More about CVS Caremark Specialty Pharmacy.
Our partnership with CVS Caremark Specialty Pharmacy makes getting the “special” drugs and supplies you need easy. CVS Caremark Specialty Pharmacy sends specialty drugs to your home, or you can pick them up at a CVS near you.To learn more about the partnership, call our Pharmacy Department at 1-800-851-3379, option 4, Monday through Friday, 8 a.m. to 5 p.m.
What is utilization management?
Utilization management actually includes a set of programs that make sure our members get the right medicine, at the right time and for the perfect amount of time. Utilization management includes:
- Managed dose limitations
What is step-therapy?
Step-therapy is a tool to control costs for some kinds of drugs. If we say a drug requires step-therapy, a member must first try the most cost-effective drug in the category. We call this a “prerequisite medication.”
In most cases, the prerequisite will work. If not, or if a doctor thinks it’s medically necessary to skip the prerequisite, he or she can request preauthorization.Check out our full list of step-therapy drugs.
What is preauthorization?
Preauthorization is approval of a drug or medical procedure before the service/drug is provided. It’s a review process requiring a member to meet special criteria before Health Alliance agrees to cover the drug or procedure. Only doctors can request preauthorization.
This may seem like a hurdle, but we do it to help keep you safe and control your costs.
Check out the list of what needs our OK. Remember, only a doctor can ask for preauthorization.
What does "managed dose limitation" mean?
The goal of managed dose limitation (MDL) is to promote safe and cost-effective use of medicines. We limit the amount of certain drugs based on what the Food and Drug Administration (FDA) recommends and the drug makers package size. Depending on your plan, MDL amounts may be different. See our managed dose limitations drug list.
We know your health is important to you—and so is saving money. So we created pharmacy savings programs just for you. They’re easy to use and can save you a lot.
How does Rxtra work?
You can save money simply by choosing a Preferred pharmacy. You don’t have to cut, clip or remember a coupon—just show your Health Alliance member ID card and save at Preferred and Preferred Plus pharmacies.
Here's how it works. We place our in-network pharmacies into three tiers—all with different savings levels.
Primary—When you visit these pharmacies, you pay the standard copayment for your plan.
Preferred—When you use Preferred pharmacies, you’ll pay nothing out-of-pocket on some of the most commonly prescribed medications.
Preferred Plus—In addition to the $0 copayments* for the drugs at Preferred pharmacies, you also pay nothing for certain cholesterol and asthma medications at Preferred Plus pharmacies.
Preferred Plus pharmacies are everywhere. We know life is busy, and having to drive across town or to another city to pick up a prescription can be a real pain. Preferred Plus pharmacies include Dierbergs, Kmart, Kroger, Walmart, Sam’s Club, Osco, Schnucks and many more.
We posted a list of pharmacies and their savings levels for members at YourHealthAlliance.org.
*$0 copayments apply after your deductible is met.
What’s Mail Order?
Our Mail Order program brings savings to your doorstep. You get a 90-day supply of your meds—delivered from a trusted pharmacy—for a discounted price.
Members can find out more about our Mail Order program at YourHealthAlliance.org.
How Can I Save With Retail 90?
Do you prefer to pick up your meds from a neighborhood pharmacy? Order a 90-day supply through a participating Retail 90 pharmacy and save.
Members can find out more about Retail 90 at YourHealthAlliance.org.
For members who take multiple medications, DailyMed delivers clearly labeled, pre-sorted packages to your home. DailyMed takes away pill sorting and gives you peace of mind, knowing you’ve taken the right meds at the right time.
Members can find out more about DailyMed at YourHealthAlliance.org.