Frequently Asked Questions
Our national pharmacy network includes 65,000 pharmacies of which 35,000 are preferred pharmacies. A prescription filled at a preferred pharmacy will have a lower copay than a prescription filled at a standard pharmacy. The lower copays apply to drugs that are Tier 1, 2, 3 or 4.
Pharmaceutical manufacturers are spending more than ever before on advertising and promotions. New drugs continue to come on the market, and drug manufacturers continue to raise the price of drugs. More people are taking more prescriptions than ever before. The result is an increase in the cost of prescription drugs for you and everyone in our community.
Our tiered drug benefit was designed to give you some relief from the increasing cost of prescription drugs.
This plan offers important advantages to you, including:
- Coverage for a wide range of medications.
- Protection for you if you need expensive medications.
- Opportunity for you to lower your out of pocket cost by using lower cost drugs whenever possible.
The tiered drug benefit provides you with a variety of choices and control of your out-of-pocket costs. For example, if you choose to get a brand drug that is on Tier 4 and there is a generic equivalent on Tier 2, you will save money choosing the generic equivalent. The tiered drug benefit is designed to provide you value with your prescription choices.
Clinical pharmacists and doctors who practice in our community, make up our Pharmacy and Therapeutics Committee. They review and evaluate the formulary list on an on-going basis for clinical effectiveness, quality and value.
You may want to talk to your doctor about the prescriptions you are taking. There may be a Tier 1 or Tier 2 drug that is less expensive and meets your needs. Or, you and your doctor may decide to continue on your Non-Preferred medication. In this case, your benefit does provide coverage for you, but you will share in the cost of the drug through the higher co-payment/coinsurance.
You will pay the lower price.
You can buy your prescription drugs at any pharmacy that participates in our nationwide network.
Yes. You may find this more convenient and cost effective. You can fill prescriptions by mail with Wegmans Home Delivery or Express Scripts Pharmacy.
View or search for medications on our current drug list.
Univera Healthcare’s pharmacy network includes limited lower-cost, preferred pharmacies. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, please call 1-877-883-9577 (TTY 711) or review the Provider/Pharmacy Directories.
Univera Healthcare is an HMO/PPO/HMO D-SNP plan with a Medicare contract and a contract with the New York State Medicaid program. Enrollment in Univera Healthcare depends on contract renewal. Submit a complaint about your Medicare plan at www.Medicare.gov or learn about filing a complaint by contacting the Medicare Ombudsman. Y0028_10520_C.
This page last updated 10-01-2024.
