Quick facts
Preventive Medications
$0 Cost share medications available at no cost to you, which includes preventive medications
Tier 0 (Preventive/$0)
$0
Tier 1A (Preferred Generic)
$88
Tier 1B (Non-preferred Generic)
$
Tier 2 (Brand/Higher-cost Generic)
$$
Tier 3 (Non-preferred Brand)
$$
Tier 4 (Specialty)
$$$
Prior Authorization (PA)
Required for certain drugs before filling prescription
More details (4)
Quantity Limits (QL)
Applied to certain drugs as listed in formulary
Step Therapy (ST)
Required to try certain drugs first before coverage of alternative
Specialty Drug Requirement (SP)
Must be filled at in-network specialty pharmacy (some LDD exceptions)
Tier 5 (Specialty - Highest Cost)
$$$
Carrier contact
1 (855) OSCAR-88 — member services
Your member ID card: check the carrier website or app, or ask HR for a copy.
Plan documents
Confirm details with your carrier for current plan information.