Your Pharmacy Details
$0 out-of-pocket drugs & supplies
With our plans, you won’t need to ration prescriptions or supplies.
Our $0 out-of-pocket Prescription List provides coverage for specific drugs for members with group or individual plans. Even without meeting your deductible or annual out-of-pocket expense.
Do you take medications in one of the categories listed below? If so, these are zero cost to Members.
$0 Drug Categories:
- Anticoagulant Medications
- Antidepressant Medications
- Blood Glucose Meter
- Bone Medications
- Cardiovascular Medications
- Cholesterol Medications
- Continuous Glucose Monitor
- Diabetic Medications
- Diabetic Supplies
- Diabetic Test Strips
- Respiratory Medications
Many insulins are available for $0
along with supplies
and glucose monitoring.
Find out if your meds may cost $0.
See if your meds are considered a Value Preventive Drug and qualifies for $0 out-of-pocket costs.
Search now and look for the ‘VAL’ label:*
*Specialty and $0 out-of-pocket value preventive medication may require fulfillment at an in-network pharmacy or prior authorization.
Specialty medication
& prior authorization
Look for these labels to determine your medication’s requirements.
What is a Specialty Medication?
These are generally prescribed to treat complex and/or chronic conditions, such as multiple sclerosis, hepatitis C, and rheumatoid arthritis.
Specialty medications that require professional services for administration are usually covered under your medical benefit plan.
Access
Your plan may require you to get self-administered specialty drugs through Mountain Health CO-OP’s preferred specialty pharmacy or another in-network specialty pharmacy.
Order Prescriptions Online
Your meds delivered.
Use the Rx information on your member benefits card to set up a profile on Birdi.
Pharmacy Mail Order – Instructions
Prescriptions from anywhere.
No appointment needed. Average wait time 5 minutes.
Virtual Doctor service can help with:
- Dosage changes
- Medication interactions
- Safe use of generic prescriptions
- And more
By putting our members first, you save time and money with the CO-OP.
Watch how >>
Help with Medications
Our clinical pharmacy management team and medical care management team work closely together to provide members with the best possible care while keeping costs low.
Discuss your pharmacy care
Care Management Team: 855 - 885 -7695
- Focus on Overall Health
- Experienced Pharmacy Management Team
- National Pharmacy Network
- Customized Benefit Designs
- 24/7 Customer Service
- Online Member Tools
- Disease & Cost Management
- Mail Order & Specialty Pharmacy Services
Drug List Abbreviations and Terms
Specialty medications are generally prescribed to treat complex and/or chronic conditions, such as multiple sclerosis, hepatitis C and rheumatoid arthritis.
These medications may be taken by mouth, injection or infusion and have special handling or storage requirements and may not be stocked by retail pharmacies.
Specialty medications that require professional services for administration are usually covered under your medical benefit plan.
Coverage for self-administered specialty medications is provided through your pharmacy benefit plan.
How to access
Your plan may require you to get self-administered specialty drugs through Mountain Health CO-OP’s preferred specialty pharmacy or another in-network specialty pharmacy.
Specialty medications are designated as Tier 4 medications in Mountain Health CO-OP’S list of covered drugs (formulary). Certain Tier 4 specialty medications require prior authorization, and your provider may submit a coverage request by using our existing medication prior authorization form or by calling UUHP Pharmacy Customer Service at 855‐885‐7695
Value Preventive Drugs are also referred to as $0 out-of-pocket drugs.
These medications are covered even before you meet your deductible or annual out-of-pocket expenses because they are considered preventive.
Preventive health care refers to proactive measures taken to maintain and improve an individual’s overall well-being and prevent the onset of illness or disease.
This means members won’t pay any money out-of-pocket for medications listed in our value-based preventive drug list or labeled with ‘Value Preventive’ on the search tool.
Mountain Health Co-Op has expanded coverage of these medications beyond what is covered at no cost-share ($0 out-of-pocket) under the Affordable Care Act (ACA).
It is available to ALL Mountain Health CO-OP plan members, including those in Individual and Family Plans, Small Group Employer Plans, and Large Group Employer Plans.
However, your plan may require you to get Value Preventive Drugs via an in-network pharmacy. Search now.
Your pharmacy benefit has four drug tiers and an additional category for no cost Preventive drugs. These tiers determine your out-of-pocket responsibility and correspond to the copays and/or coinsurance shown on your benefit summary. Tier 1 drugs are preferred generics with the lowest copay. Tier 2 drugs are non-preferred generics and preferred brands with a mid-range copay. Tier 3 drugs are non-preferred brands with a high copay. Tier 4 drugs are specialty drugs (most require prior authorization and must be filled at the Plan’s designated Specialty Pharmacy).
Drugs listed in our additional Preventive Drug Benefit have no member cost share, even before deductible.
Pre-authorization helps encourage safe, cost-effective use of prescription drugs by requiring a “prior authorization” request from your physician before the drug will be covered. If PA appears in the Requirements column, the drug requires pre-authorization from your physician before the drug will be covered.
QL stands for quantity limits. If QL appears in the requirements column, the drug may be covered by your plan, but only up to a certain quantity or limit. If you need quantities higher than the limit shown, have your provider fax a preauthorization request to us.
SP stands for specialty or biotech drug. In most cases, specialty drugs are required to be filled at a designated specialty pharmacy. Check your member handbook or Summary of Benefits to find the specialty drug copay amount or deductible amount.
SP stands for Step Therapy, a program that requires you to try a lower-cost alternative medication (“Step 1 Drugs”) before using the more expensive (“Step 2”) medication. If it is medically necessary for you to use a Step 2 medication as initial therapy, your provider can submit an exception request to us.
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