Utilization Management Requirements

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Utilization Management Requirements

For certain prescription drugs, special rules restrict how and when the plan covers them. A team of doctors and pharmacists developed these requirements to help our members use drugs in the most effective ways. These special rules also help control overall drug costs, which keeps your drug coverage more affordable.

In general, our rules encourage you to get a drug that is safe and works for your medical condition. Whenever a safe, lower-cost drug will work medically just as well as a higher-cost drug, the plan’s rules are designed to encourage you and your doctor to use that lower-cost option.

Please refer to our 2020 Comprehensive Premium Formulary to determine specific drug coverage information.

Note: The Utilization Management (UM) Requirements will be available soon.

 

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