Pharmacy

Find drug options for your health condition, compare prices at different pharmacies, and see if cash back is available for your medication. Log in to your PEHP account, then click “Providers, Facilities, and Costs” in the menu, then visit the “Compare Prescription Costs” tab. You often can spend less by ordering up to 90-day supplies through home delivery.

You pay cost sharing based on the tier of drug:

• Tier 1: Preferred generic medications that are available at the lowest copayment/coinsurance.
• Tier 2: Preferred brand name medications that are available at an intermediate copayment/coinsurance.
• Tier 3: Non-preferred medications that are available at the highest copayment/coinsurance.

Save money by going with generic alternatives when available. Here’s why:

• Generic drugs usually offer the lowest out of pocket spending.
• Generic drugs are safe, effective, and produce the same effects as the comparable brand name.
• If you choose to use a brand name drug when a generic is available, you’ll pay the difference in price.

If you have diabetes, you can get fast-acting Insulin Lispro (generic Humalog) at No Cost. See a list of other benefits available to help manage diabetes at www.pehp.org/diabetes

Step therapy is a process that helps ensure patients start with the safest and most cost-effective drugs before moving to more expensive alternatives.

Step therapy involves:

1. Starting with a first-line treatment, usually a generic or lower-cost drug.
2. If the initial drug is ineffective or causes side effects, moving to a second-line treatment.
3. If the second-line treatment is ineffective or causes side effects, progressing to additional medications as necessary.

Benefits

1. Safety: Using medications with a proven safety record first.
2. Cost Savings: Saving money by starting with lower-cost drugs.
3. Personalized Care: Ensuring a structured plan to find effective treatments.

Navigating Step Therapy

• Consult Your Doctor: Discuss any concerns and navigate step therapy requirements.
• Appeal Process: Your doctor can help submit an appeal if a higher-step medication is needed.
• Stay Informed: Familiarize yourself with our formulary and step therapy protocols.

At PEHP, step therapy helps balance cost-efficiency and patient safety, ensuring effective and affordable healthcare for all our members.