Filling prescriptions: HMO plans

Check the Medicaid Approved Drug List (ADL) to see what drugs are covered and how.
You must get your prescriptions from a network pharmacy. Check the list of participating pharmacy chains, or search for pharmacies in our online Find a Doctor tool to find a pharmacy near you.
You must bring your Priority Health ID card with you to the pharmacy. Your ID card has important billing information the pharmacy will need to bill your prescription. A digital copy of your ID card is available in your member account.

To use Find a Doctor:

Log in or create a member account
Select Find care in the top menu
Click Find a doctor or specialist.

Note that out-of-network PCPs or specialists must be authorized before a visit (called “prior authorization”). Your in-network PCP can help coordinate all referrals to specialists.

Drug tiers

"Tiers" are simply a way of grouping prescription drugs by cost and purpose. Generic drugs are the least expensive because they are not brand names. It's the difference between buying Kleenex^® Tissue and other tissues; some are equivalent to brand-name products in the way they're made, and some just treat the same conditions, but they cost less, so your copay may be lower.

"Preferred brand" drugs may cost more than a generic, but you'll often pay a lower copayment than for non-preferred brand drugs.
"Non-preferred brand" drugs are the most costly drugs, so your copayment may be higher with these prescriptions. Ask your provider to prescribe a generic or preferred drug whenever possible.
"Preferred specialty" drugs are generally self-administered medicines used for a chronic illness. They have special handling requirements or require special training before use.
"Non-preferred specialty" drugs are more costly than the preferred specialty drugs. Ask your provider to prescribe a preferred specialty drug whenever possible.

Tier 1a: ($) The least expensive prescription drugs available to you. This tier includes lowest-cost generic drugs—proven to be as safe as brand-name drugs—and, on some formularies, select brand-name drugs.

Tier 1b: ($) This tier includes low-cost generic drugs—proven to be as safe as brand-name drugs—and, on some formularies, select brand-name drugs.
Tier 2: ($$) Includes preferred and lower cost brand-name drugs, and some higher cost generic drugs. If you must take a brand-name drug, you should work with your provider to choose one that is covered here, and the most affordable.
Tier 3: ($$$) Non-preferred and expensive brand-name drugs, as well as higher-cost generic drugs. These drugs may cost you a significant amount out of pocket so you should ask your provider if a tier 1 or 2 option can be prescribed instead.
Tier 4: ($$$$) Includes very expensive brand-name and generic drugs, and preferred specialty drugs used to treat complex conditions. Specialty drugs often have high costs and may have special handling or storage requirements. They are usually dispensed by trained personnel at specialty pharmacies. If you need to take a specialty drug, you should work with your provider to choose one that is covered here. These drugs do not typically have a specific copay. Instead, you may pay a percentage of the total cost, up to a maximum amount per prescription.
Tier 5: ($$$$$) Non-preferred specialty drugs, and the most expensive brand-name and generic drugs are covered here because they offer limited clinical value. Most have a similar lower-cost option offering the same clinical value on tiers 1 through 4. Ask your provider about alternatives. These drugs typically do not have a specific copay. Instead, you may pay a percentage of the total cost, up to a maximum amount per prescription.
Tiers 6-8: ($$$$$$) A drug that is covered by your medical plan benefits instead of your prescription plan benefits. Check your plan documents for details.

Tier 9: ($$$$$$$$) A drug that your prescription plan will not pay for or that is not included on the Approved Drug List. Check your plan documents for details.