Pharmacy Programs

 

Formulary/Covered Drugs

To see the list of drugs covered by your plan, choose the appropriate link:

Individual Plans - Direct Marketplace Formulary.
Individual Plans - Public Marketplace Formulary.

Employer Group Plans - Standard/Non-Exchange Formulary
Employer Group Plans - Public Exchange Formulary.

You may also view the Specialty Drug List to see which meds have special instructions or need to be administered by a health care professional.

See more about formularies and other provider and pharmacy directories on the Forms & Resources page. 

Pharmacy Choice

Unless it’s an emergency, you must go to an in-network pharmacy for your prescriptions to be covered. For a list of in-network pharmacies, view our pharmacy directories or log in to YourHealthAlliance. Medicare members can also view their pharmacy directories on Medicare Forms & Resources.

Unless it’s an emergency, you must go to an in-network pharmacy for your prescriptions to be covered. For a list of in-network pharmacies, view our pharmacy directories or log in to YourHealthAlliance. Medicare members can also view their pharmacy directories on Medicare Forms & Resources.

To learn more about the basics of Insurance, check out our Understand Insurance section.

Where can I fill my meds?

For your meds to be covered, you have to fill your prescription at a partner (in-network) Health Alliance pharmacy. The good news is they’re easy to find.

Here’s a short list of some of our partner pharmacies:

  • ABCO
  • CostCo
  • CVS
  • Doc’s Drugs Ltd.
  • Dominick’s
  • Fagen Pharmacy
  • Horizon Pharmacy
  • Hy-Vee Foods
  • Kmart
  • Kroger
  • Longs
  • Medicine Shoppe
  • Meijer
  • Nash Finch Company
  • NCS Healthcare Inc.
  • Payless
  • Revco Discount Drug Centers
  • Rite Aid
  • Safeway
  • Sav-Mor
  • Schnucks
  • ShopKo
  • Target
  • Walgreens
  • Walmart

Many small pharmacies are also in our network. 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.—5 p.m. Also, check out our Preferred pharmacies to save money on every refill.

What are tiers?

Our pharmacy plans work on a tier-system. For the lowest tier, you pay the lowest copayment. As you step up to the next tier, what you pay increases.

Before filling a prescription, it’s smart to check the Health Alliance Drug Formulary. This lists the most commonly prescribed meds that we cover and their tiers. They don’t list all drugs, so if you don’t see your med, call our Pharmacy Department at 1-800-851-3379, option 4, Monday through Friday, 8 a.m..—5 p.m.

What is a formulary?

A formulary is a list of the most commonly prescribed meds that we cover and their tiers, so how much they cost. The meds on it are organized by drug class, meaning they work in a similar way, or medical condition.

Our Pharmacy Department and doctors decide which drugs to include based, on quality, safety and how well they work. It includes both generic and brand-name.

What are specialty drugs?

Specialty drugs help members deal with complex diseases like cancer, rheumatoid arthritis, and multiple sclerosis.

Why are they so special?

  • Doctors must request preauthorization from Health Alliance for most of them. This is to make sure you meet the rules for getting that drug covered.
  • Doctors must also closely watch how these drugs are used, stored, and given – orally, injected or by IV – either at a health care facility or at home.
  • Sometimes, only certain pharmacies carry them.

See our Specialty Drugs List.

We partnered with CVS Caremark Specialty Pharmacy to make getting the specialty drugs and supplies you need easy. They send them to your home, or you can pick them up at a CVS near you. To learn more about this, call our Pharmacy Department.

To learn more about the partnership, call our Pharmacy Department at 1-800-851-3379, option 4, Monday through Friday, 8 a.m.—5 p.m.

What is step-therapy?

Step-therapy helps control your costs for some kinds of drugs. If we say a certain drug requires step-therapy, you have to try the cheapest drug in that category first. We call this a prerequisite medication.

In most cases, this drug will work for you. If it doesn’t, or if a doctor thinks it’s medically necessary to skip the prerequisite, they can request preauthorization.

See our full Step-Therapy Drugs List.

What is preauthorization?

Preauthorization is approval of a drug or service before you get it. It is a review process to make sure that a member meets certain requirements before we agree to cover it. Only doctors can request this.

We do this to help keep you safe and to control your costs.

Check the full Preauthorization Drug List.

What does "managed dose limitation" mean?

Managed dose limitation (MDL) limits the amount of certain drugs you’re given based on the drug maker’s package size and what the Food and Drug Administration (FDA) recommends. It helps make sure your medicines are safe and affordable.

Depending on your plan, MDL amounts may be different. See our Managed Dose Limitations List.

Prescription Coverage with New Plans

Prescription coverage is included with a number of Health Alliance plans. You can also add prescription coverage to other plans. Then you have one plan for all of your needs.

Individual Plans  Group Plans

Rxtra

Rxtra

With Rxtra, you can save money simply by using a Preferred pharmacy. We have three kinds of in-network pharmacies – all with different savings levels.

  • Primary – When you use these pharmacies, you pay the standard copayment for your plan
  • Preferred – When you use these pharmacies, you get $0 copayments* on some of the most commonly prescribed medications. See our Preferred Drugs List.
  • Preferred Plus – When you use these pharmacies, you get the same $0 copayments* as Preferred pharmacies, but you also pay nothing for certain cholesterol and asthma medications. See our Preferred Plus Drugs List.

We find ways to make using your coverage easy – because life is already hectic enough. So Preferred Plus pharmacies are everywhere. They include Dierbergs, Kmart, Kroger, Walmart, Sam’s Club, Osco, Schnucks and many more. Just show your Health Alliance member ID card to save.