Understanding your HealthSelect plan’s prescription drug formulary
Understanding the drug formulary covered by your health plan could mean paying less for your medications.
What is a drug formulary? Who creates it?
Under the Texas Employees Group Benefits Program (GBP), the drug formulary is a list of the most commonly prescribed medications the HealthSelect of Texas® and Consumer Directed HealthSelectSM plans cover. The list includes both generic and brand-name prescription medications approved by the Food and Drug Administration (FDA).
A committee of doctors and insurance industry experts develop the HealthSelect plans’ formulary based on how well the medications work, how safe they are and the medication’s therapeutic class. A therapeutic class is a group of medications that treat a specific health condition. For example, antibiotics—which are commonly used to treat bacterial infections—are a therapeutic class.
The formulary lists the medications by classes and places them in drug tiers.
What is a drug tier?
Drug tiers are the different cost levels you will pay out of pocket for a medication on the formulary. The HealthSelectSM Prescription Drug Program (PDP), administered by OptumRx, assigns a cost to each tier. That cost is the amount you will pay out-of-pocket when filling a prescription for a medication on that tier.
The HealthSelect PDP has three drug tiers:
Tier 1 medications have the lowest out-of-pocket costs. Tier 1 includes mostly generic and some brand-name medications. You can talk to your provider to see if there is a Tier 1 medication available.
- Tier 2 medications have mid-range out-of-pocket costs. Tier 2 includes both brand-name and generic medications. If your provider approves, you can use Tier 2 medications instead of Tier 3 to help save money.
- Tier 3 medications have the highest out-of-pockets costs. Tier 3 includes mostly brand-name and specialty medications, and some generics. To reduce your out-of-pocket cost, you can ask your provider if a Tier 1 or Tier 2 option can work for you.
Other than cost, are there other restrictions on what medications are covered?
Some medications may have extra requirements—such as prior authorization and quantity limit. Visit www.healthselectrx.com and check out “Understanding your formulary” under the “Education resources” tab to see other possible restrictions. You should talk to your provider about whether any restrictions apply to medication you take.
Does the HealthSelect plans’ formulary ever change?
Formulary changes typically happen twice a year. (This is standard in the insurance industry, not just for HealthSelect.) Some formulary changes and adjustments that have a positive impact on you—such as new medications and cost savings—can happen at any time.
For more information about your HealthSelect plan’s formulary
Before filling your next prescription, visit the HealthSelect PDP website to search lower-cost options with the drug pricing tool. If you have additional questions about the HealthSelect PDP and/or your formulary, contact an OptumRx customer care representative at (855) 828-9834 (TTY: 711), 24 hours a day, seven days a week.