Prescription Drugs
Your drug therapy is an important part of your health care. HMSA
promotes proper use of prescription drugs and works to help
keep your share of drug costs down.
Explanation of Formulary
Your HMSA drug plan is designed to give you a choice of prescription drugs
while you share in the cost through copayments:
- First tier (generic drugs – lowest copayment): Generic drugs are sold
under their common generic or chemical name. Generics have the same active
ingredients as their brand-name equivalents and have been found to be safe
and effective by the U.S. Food and Drug Administration (FDA). We encourage
the use of generics because their low cost results in the lowest copayment for you.
- Second tier (preferred brand drugs – higher fixed copayment): Some
brand-name drugs are designated as preferred brand drugs when generic
alternatives are not available or do not adequately represent a therapeutic
class. For preferred brand drugs, you pay a higher, fixed copayment than for generics.
- Third tier (other brand drugs – higher fixed copayment plus differential):
Other brand drugs have a higher member copayment. For most members, the
out-of-pocket cost for other brand drugs is the second-tier copayment plus
the differential. The differential is the difference between the average cost
for other brand drugs and the average cost for generic and preferred brand drugs.
Choose Generic
The high cost of prescription drugs is a critical factor in rising health care costs
locally and nationally. HMSA encourages the use of generic drugs to help our members
manage their prescription drug costs. Generic drugs contain the same active ingredients
and are safe and just as effective as brand-name drugs. The biggest difference is
that generic drugs cost less because generic manufacturers don’t have the investment
and marketing costs of the developer of a new drug. Talk to your doctor or pharmacist
about receiving a generic prescription if appropriate for your condition.