Coverage Tiers
The Elixir/MedImpact plan includes a four-tier 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 many generic drugs for high blood pressure, high cholesterol, depression, and diabetes. It also includes preferred brand products for thyroid disease, as well as preferred brand and generic diabetes test supplies, insulin, and continuous glucose monitors.
- Tier 2 includes all other generic drugs. Generic drugs are required by the FDA to contain the same active ingredients as their brand-name counterparts.
- Tier 3 includes preferred brand-name drugs.
- Tier 4 includes non-preferred brand-name drugs.
Tier Exceptions:
A copay exception may be available if you are taking a Tier 4 medication and your physician submits a Letter of Medical Necessity (LMN). The LMN is a letter from your physician to Elixir/MedImpact that sufficiently documents the reason(s) why you are unable to tolerate the Tier 3 medication. If Elixir/MedImpact authorizes the LMN exception, you will pay the Tier 3 copay instead of the Tier 4 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 Elixir/MedImpact.
