Page 28 - SIH 2022 Re-Enrollment Guide
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PRESCRIPTION DRUGS
About MaxorPlus Three-Tier Prescription Benefit
MaxorPlus is a Pharmacy Beneits Manager helping Tier 1: Generic Drugs
optimize pharmacy beneit programs and shifting the You and SIH receive the best value by using FDA-
focus back to you and your care.
approved generic drugs whenever medically
With pharmacy beneit services nationwide and appropriate. For this reason, members pay the lowest
access to over 66,000 pharmacies across the US, copayment ($10*) for generic drugs.
MaxorPlus provides a clinically focused, evidence-based
prescription drug formulary and clinical pharmacy Tier 2: Preferred Brand-Name Drugs
services.
This tier includes many brand-name drugs, which
MaxorPlus has determined provide the best value and
SIH ofers an evidence-based prescription therapeutic quality for members. Medications in this
drug program in our prescription drug beneit. tier require a higher copayment ($35*) than tier 1 drugs.
MaxorPlus, with recommendations and support
by RxResults, LLC, administers this program. Tier 3: Non-Preferred Brand
This tier includes brands that are not on the MaxorPlus
The evidence-based prescription drug program Preferred Drug List. Medications in this tier have the
is designed to help keep healthcare costs down highest copay ($60*).
for both you and our healthcare plan while
promoting healthy outcomes and conforming * Some drugs may be Reference Priced and have a diferent or higher
member cost than the standard drug copays. You will be notiied if your
to national guidelines and/or best practices with drug will have a higher cost.
respect to drugs used to treat certain medical
Retail
conditions. Managing prescription costs also Medication Type (30-day supply) Retail/Mail Order
(90-day supply)
helps control future health plan premium costs Tier 1—Generic $10 $25
for our employees. Tier 2—Preferred Brand $35 $87
Tier 3—Non-Preferred Brand $60 $150
SIH values and promotes the health of our
employees and their covered family members. Mandatory Generic
We believe the evidence-based prescription drug If a Generic equivalent is available and either a
program helps ensure you continue to have a Preferred Brand or Non-Preferred Brand drug is
high quality, cost-efective prescription drug dispensed, the DAW penalty will be applied in addition
beneit.
to your copayment. A Dispense as Written (DAW)
penalty is the diference in price between the brand
name medication and its available generic equivalent.
However, if your physician believes a brand-name
drug is medically necessary for you, he or she may
submit a letter of medical necessity to MaxorPlus for
review. If approved, you will still be required to pay the
applicable brand copay, but you will not be required to
pay the DAW penalty.
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About MaxorPlus Three-Tier Prescription Benefit
MaxorPlus is a Pharmacy Beneits Manager helping Tier 1: Generic Drugs
optimize pharmacy beneit programs and shifting the You and SIH receive the best value by using FDA-
focus back to you and your care.
approved generic drugs whenever medically
With pharmacy beneit services nationwide and appropriate. For this reason, members pay the lowest
access to over 66,000 pharmacies across the US, copayment ($10*) for generic drugs.
MaxorPlus provides a clinically focused, evidence-based
prescription drug formulary and clinical pharmacy Tier 2: Preferred Brand-Name Drugs
services.
This tier includes many brand-name drugs, which
MaxorPlus has determined provide the best value and
SIH ofers an evidence-based prescription therapeutic quality for members. Medications in this
drug program in our prescription drug beneit. tier require a higher copayment ($35*) than tier 1 drugs.
MaxorPlus, with recommendations and support
by RxResults, LLC, administers this program. Tier 3: Non-Preferred Brand
This tier includes brands that are not on the MaxorPlus
The evidence-based prescription drug program Preferred Drug List. Medications in this tier have the
is designed to help keep healthcare costs down highest copay ($60*).
for both you and our healthcare plan while
promoting healthy outcomes and conforming * Some drugs may be Reference Priced and have a diferent or higher
member cost than the standard drug copays. You will be notiied if your
to national guidelines and/or best practices with drug will have a higher cost.
respect to drugs used to treat certain medical
Retail
conditions. Managing prescription costs also Medication Type (30-day supply) Retail/Mail Order
(90-day supply)
helps control future health plan premium costs Tier 1—Generic $10 $25
for our employees. Tier 2—Preferred Brand $35 $87
Tier 3—Non-Preferred Brand $60 $150
SIH values and promotes the health of our
employees and their covered family members. Mandatory Generic
We believe the evidence-based prescription drug If a Generic equivalent is available and either a
program helps ensure you continue to have a Preferred Brand or Non-Preferred Brand drug is
high quality, cost-efective prescription drug dispensed, the DAW penalty will be applied in addition
beneit.
to your copayment. A Dispense as Written (DAW)
penalty is the diference in price between the brand
name medication and its available generic equivalent.
However, if your physician believes a brand-name
drug is medically necessary for you, he or she may
submit a letter of medical necessity to MaxorPlus for
review. If approved, you will still be required to pay the
applicable brand copay, but you will not be required to
pay the DAW penalty.
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