We aim to provide high-quality, cost-effective drug options for your Network Health patients. We work with you to make sure we cover the most important and useful drugs for all types of conditions and diseases.
Pharmacy co-payments by plan
Preferred Drug List
Our Preferred Drug List (PDL) is a tool to promote appropriate and cost-effective prescription drugs for our members. Refer to our PDL to make sure you prescribe your Network Health patients drugs we cover. Our Pharmacy and Therapeutics (P&T) Committee reviews and revises our PDL on a quarterly basis to reflect the committee's prevailing clinical opinion. Each quarter, we announce PDL updates via our online newsletter, Provider Update.
To quickly find out if we cover a specific drug, you can search our Searchable Drug List by generic name, brand name, or drug class to find information about cost (drug tier), coverage, and limitations (prior authorization, quantity limits, step care). You can also download a PDF version of the PDL:
Some drugs in our PDL require prior authorization. To request a drug authorization, please submit the appropriate prior authorization form. We review requests and make initial determinations regarding prior authorizations within two business days of receiving complete medical information. Once we make a decision, we will notify you by telephone or fax within one business day.
Over-the-counter drug list
Our pharmacy benefit covers select over-the-counter (OTC) drugs for Network Health Together, Network Health Forward, and Network Health Extend members. If your patient needs a covered OTC drug, please write a prescription that your patient can fill at a pharmacy at no cost, or with only a small co-payment.
We do not cover OTC drugs for Network Health Choice members.
For all of your Network Health patients, you can prescribe:
- Up to a 30-day supply of medication
- Up to a 60-day supply of dextroamphetamine or methylphenidate for the treatment of ADHD or narcolepsy
- Supplies for members with diabetes
For your Network Health Forward Plan Type II and III, Network Health Extend Plan Type II and III, and Network Health Choice patients, you can also prescribe a 90-day supply of maintenance medications when filled through our mail-order pharmacy, Wellpartner.
For your Network Health Together, Network Health Forward, and Network Health Extend patients, you can also prescribe:
- OTC smoking cessation products
- Spacer devices for oral inhalers and peak flow meters for members with asthma