Drug Formularies

The Health Plan Formulary is a listing of generic and brand-name prescription medications that are preferred for use by The Health Plan. The Health Plan maintains an open formulary with certain restrictions across several therapeutic classes. In these classes, the preferred drugs will be a covered benefit when dispensed at participating pharmacies.

The Health Plan may add or remove drugs from our formulary during the year. To inquire about the status of a drug on the formulary visit www.medcohealth.com or call Customer Service at 1.800.592.4465 in the Ohio Valley/Mountaineer Region or 1.800.593.0339 in the HomeTown Region, 24 hours a day, 7 days a week, except Thanksgiving and Christmas. For the hearing and speech impaired (TTY/TDD) call 1.800.716.3231. If we remove drugs from our formulary, or add prior authorization, quantity limits and/or step therapy restrictions on a drug, or move a drug to a higher cost-sharing tier, we must notify members who take the drug that it will be removed at least 60-days before the date that the change becomes effective, or at the time the member requests a refill of the drug, at which time the member will receive a 60-day supply of the drug. If the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug's manufacturer removes the drug from the market, we will immediately remove the drug from our formulary and provide notice to members who take the drug.

Members with a three-tiered benefit will have coverage of non-preferred drugs at the highest or third tier. Members prescribed with a non-preferred drug are encouraged to consult their provider to see if they can use a first- or second-tier drug for their condition.