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What's Covered/Formulary

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The following Preferred Medication List/Formulary (PML) can assist you in choosing a generic or brand-name medication. Please Note: This Preferred Medication List/Formulary does not apply to new individual and small group (Metallic) plans with effective dates 1/1/2014 and after. Refer to the health plan website for formulary information.

  • Generic Medications - A large number of generic medications are available. If you choose a generic, you will most likely pay the least amount for these medications. Generics provide the same high quality and therapeutic benefit as brand-name medications, without the brand-name price.
  • Brand-Name Medications - Brand-name medications listed on the PML/Formulary are available at your brand copay (or coinsurance) level. They are owned (protected by patent) and manufactured by a specific company. When the patent expires on a brand-name medication, that medication can then be manufactured and distributed by other companies.

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PPACA Preventive Care Medication List (PDF) – Under the Affordable Care Act passed in 2010, Regence covers certain preventive medications with a prescription, at 100% with no copay when you obtain medications from an in-network pharmacy.  More information on PPACA Preventive Coverage is also available on Regence.com. This list is subject to change.

Coverage for Smoking Cessation (PDF)

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Self-Administered Chemotherapeutic Medication List (PDF) – The following prescription drug medication list applies to patients whose diagnosis requires treatment through self-administered anticancer medication.

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Medication Cost Integration (MCI) Formulary - The following prescription drug and major medical medication lists apply to Regence members who have the MCI benefit. 

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Value-Based Benefits Medication List (PDF) (Not related to Health Care Reform.) - This standard drug list applies to Regence members who have a value-based or rewards-based medication benefit. This list does not pertain to provisions of federal health care reform, the Patient Protection and Affordable Care Act.

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Value-Plus Medication List (PDF) - This enhanced drug list applies to Regence members who have a Value-Plus medication benefit. This list covers therapeutic categories that are also covered under the Value-Based Medication list but includes medications and therapeutic categories not available in the standard plans. This list does not pertain to provisions of federal health care reform, the Patient Protection and Affordable Care Act.

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Optimum Value Medication List, 2014 (PDF)
Optimum Value Medication List, 2015 (PDF)
You may not need to meet any deductible, or even have any financial responsibility depending on your specific benefits, when you fill prescriptions on this list. It includes generic medications and formulary brand-name medications specifically designated for treatment of chronic diseases.

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Non-Formulary Medications
Any medication not listed on the PML is not on the formulary. If you have a three-tier copay/coinsurance plan, the non-formulary medication is only available at the highest copayment or at your own expense if you have a closed formulary design.

View a list of Alternatives to Non-Formulary Medications.

Questions?
If you have questions about your prescription benefits, please call the number on the back of you member card, or the TTY line for people with hearing impairments at 711, a free service provided by the Public Utility Commission.

We encourage you to share this information with your doctor and other medical providers.