Coverage Tiers
The MedImpact plan includes a tiered prescription benefit. Tiered prescription drug plans require varying levels of payment depending on the drug’s tier, and your copayment or coinsurance will be higher with a higher tier number.
- Tier 1 includes generic drugs.
- Tier 2 includes preferred brand-name drugs.
- Tier 3 includes non-preferred brand-name drugs.
Tier Exceptions:
A copay exception may be available if you are taking a Tier 3 medication and your physician submits a Letter of Medical Necessity (LMN). The LMN is a letter from your physician to MedImpact that sufficiently documents the reason(s) why you are unable to tolerate the Tier 2 medication. If MedImpact authorizes the LMN exception, you will pay the Tier 2 copay instead of the Tier 3 copay.
“Dispense as Written” (DAW):
Also, it is important to note that if you purchase a brand name prescription when there is a generic equivalent available, you will pay the brand copay plus the difference in cost between the brand name and the generic. However, should your physician indicate “Dispense as Written” on the brand name prescription and provide documentation showing that the brand name prescription is medically necessary, the cost difference penalty will be waived if authorized by MedImpact.
