Covered Drugs & Preauthorization

These pharmacy benefits don't apply to some school districts and all Medicare Supplement members. Check with your employer.

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

You can access your Express Scripts Account via your PEHP account. Under the My Benefits menu, choose “Access Express Scripts Account.”

PEHP Covered Drug List

The Covered Drug List 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 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.

Preauthorization

Some drugs require preauthorization due to their potential for misuse, adverse reactions, safety issues, and cost. 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.