Orchard - Unchanged

Covered Drugs & Preauthorization

PEHP pharmacy benefits do not apply to the following groups: Jordan School District, Salt Lake City School District, Park City Schoold District, USBA, Medicare Supplement.

Important! Beginning January 1, 2023 – Kroger/Smith's pharmacy will no longer be part of the Express Scripts pharmacy network. That means if you go there for prescriptions you will end up paying more than you should for your medications. To find an in-network pharmacy, please call Express Scripts at 877-231-4239.

Access Your Express Scripts Personal Account for the following:

  • Sign up for home delivery
  • See Rx history
  • Find in-network pharmacies

PEHP Covered Drug List

The Covered Drug List PDF file is a listing of prescription medications that provide the best overall value based on quality, safety, effectiveness, and cost. Your prescription drug benefit is categorized into four co-payment tiers:

  • Tier 1: Preferred generic medications that are available at the lowest co-payment.
  • Tier 2: Preferred brand name medications that are available at a median co-payment.
  • Tier 3: Non-preferred medications that are available at the highest co-payment.
  • Tier 4:
    • Tier A: Specialty medications available at the lowest specialty co-payment
    • Tier B: Specialty medications available at the intermediate specialty co-payment
    • Tier C: Specialty medications available at the highest specialty co-payment

Ask your doctor to refer to the Covered Drug List PDF file when he/she is choosing a prescription medication. Choosing a preferred generic or brand name drug will ensure the lowest possible co-payment. Please note the Covered Drug Lis may be modified periodically with changes.

Are you on the Consumer Plus Plan? See the Consumer Plus Covered Drug List. PDF file

Preauthorization

Some drugs require preauthorization due to their potential for misuse, adverse reactions, safety issues, and cost. See list of medications that require preauthorization. To get preauthorization, your doctor must call PEHP (801-366-7555). Most doctors know how and when to do this, but it's your responsibility to verify. Otherwise, your benefits could be reduced or denied.