Drug Exception Time Frames and Enrollee Responsibilities
I’m on an Individual plan. What is my formulary and how does it work?
All Individual plans include our RxCore formulary (Utah) (Idaho). A formulary is a list of covered prescription drugs. In an effort to help keep your costs as low as possible, RxCore excludes more expensive brand-name drugs when there is a lower-cost generic option or over-the-counter equivalent available. A generic drug is a medication with the same active ingredients, safety, dosage, quality, and strength as its brand-name counterpart. Providers and pharmacists agree that generic medications are as safe and effective as brand-name drugs.
Individual plan RxCore pharmacy benefits have four tiers (levels) of coverage. Each tier includes different drugs and copays/coinsurance. Tier 1 medications are available at the lowest cost. On some plans, the pharmacy deductible does not apply to these drugs.
Certain medications are not covered. If you have questions before applying for coverage or using your pharmacy benefits, call Member Services or visit the Pharmacy section of our website. You may also search our list of covered medications online or call to request a copy.