Tiered Drug Formulary
Rx Choices is a unique tiered benefit listing that offers coverage for many medications. Medications eligible under the Rx Choices formulary follow the decisions of our Medication Advisory Panel (MAP) and are separated into two tiers, with the coinsurance (the amount your plan covers) varying amongst the tiers. Prior authorization* is only required on eligible specialty drugs (annual cost of $10,000 or more).
*Tier or copay may vary by plan; please review your member booklet.
Higher Coinsurance (Plan Pays)
With a higher coinsurance, you pay less out-of-pocket. The drugs on this tier are more cost-effective, and follow widely accepted treatment guidelines for many acute and chronic conditions. This tier includes both the brand and its interchangeable generics.
Lower Coinsurance (Plan Pays)
The drugs on this tier typically have lower cost alternatives available on Tier 1, or are generally for less serious medical conditions. This tier includes both the brand and its interchangeable generics. Drugs not approved by MAP but required under the Régie de l’assurance maladie du Québec (RAMQ) are also included on this tier (applies to Quebec residents only).
How do I know which tier my drug is on?
Please visit this page for a listing of the most commonly prescribed categories with Tier 2 medications, and the lower cost alternatives available on Tier 1.
If you prefer, you can email us at [email protected] with any questions you may have, including which tier your drug is on.
Smart spending on prescription drugs
Every day we make wise decisions when it comes to our finances; from buying a preferred brand at the grocery store, to choosing an affordable contractor when renovating our home. When it comes to your health care, you also play an important role in helping to keep plan sustainable by making wise consumer choices.