First Health® Rx
   Frequently Asked Questions

 


How is the drug list developed?
What is a tier? 
How do I know if the patient's plan covers a certain drug?

 

How is the drug list developed?

The drug list is developed and administered by the First Health Pharmacy and Therapeutics Committee, which consists of medical directors and pharmacists. This committee reviews and updates the drug list periodically. All FDA-approved drugs are included on the First Health® Rx drug list, but certain drugs may be excluded from your patient's plan. Patients should contact their benefits department to view the complete drug list and their plan's drug exclusions.

Please understand that this drug list is not intended as a substitute for a doctor's professional judgment. It is offered as a tool to help you and your patient maximize treatment effectiveness while taking into account both drug therapy needs and costs.

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What is a tier?

Drugs on the First Health® Rx drug list are placed in tiers by the Pharmacy and Therapeutics Committee following review of their safety, clinical effectiveness, and various financial considerations. Tier one contains most preferred drugs, tier two preferred brand, and tier three, non-preferred brand drugs.

Tier one (most preferred drugs) contains most A-rated generics. These generics are generally the most affordable prescription drugs. A-rated generic drugs meet the same FDA standards, and have the same chemical composition as their brand-name equivalents.

Tier two (preferred brand drugs) contains brand-name drugs that the Pharmacy and Therapeutics Committee evaluated as being clinically superior, safer, or more cost effective than other similar brand drugs. 

Tier three (non-preferred brand drugs) contains drugs that the Pharmacy and Therapeutics Committee has evaluated as having no established clinical or cost advantages over the same or similar brand-name drugs. For the purpose of individual choice or need, you or your patient may decide that you prefer drugs on this tier.

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How do I know if the patient's plan covers a certain drug?

Although all FDA-approved drugs are included in the First Health® Rx drug list, this is not a guarantee of coverage. The level of prescription drug benefits is based on your patient's plan, as well as on the status of each drug at the time your patient fills the prescription. Coverage is not based on the printed or Internet versions of the drug list. Although the printed and Internet drug lists were current at the time of publication, they are subject to change. Patients can call the toll-free number listed on their ID card with any questions about their prescription drug benefit. 

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