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Prescription Coverage
For All Your Needs

Prescription Plans That Work For You

It’s important to consider the number of prescriptions you and your family have when you are looking for a new health plan. We are committed to providing you with the best prescription coverage options available. We offer a tiered prescription plan to help accommodate the needs of our members with costs as well as selection of certain medications.

EnvisionRx

We partner with EnvisionRx to administer prescription benefits for our members. EnvisionRx provides many online tools to help you including:

  • Locating a participating pharmacy
  • Prescription drug pricing
  • Helpful drug information
  • Mail order administration and ordering

You can view your member benefits by logging in to EnvisionRx’s secure site at www.envisionrx.com/. You will need to enter your Member ID number on your identification card and Date of Birth to log in.

EnvisionRx Pharmacy Technicians are also available 24 hours a day/7 days a week to assist you with your pharmacy needs. You can call toll free at (800) 361-4542.

Making the Right Prescription Choices

Prescription Formularies give details of the covered medication tier levels and quantity limits. Download the formulary for the type of health plan you are covered under below.

Metal Plans – Gold, Silver, and Bronze plans that are purchased for Families and Individuals or offered by your Employer (50 or less employees).

for Individual and Small Group Metal Health Plans:

Download PDF

Large Employer Groups &Transitional Plans – Plans offered by your Employer for companies that employee 51 or more employees or Small Group and Individual plans purchased prior to January 2014.

for Large Employer and Transitional Plans:

Download PDF

2017 Formulary Changes

for Large Employer Groups, Transitional Plans and Cox Employee Self-Funded Health Plan

Download PDF

Cox Employee Self-Funded Health Plan – Plans offered to Employees of CoxHealth.

for Cox Self-Funded Health Plan:

Download PDF

for Cox Self-Funded MEC Plan:

Download PDF

Pharmacy Benefit Limitation List

Download our Pharmacy Benefit Limitation PDF to learn which medications might require additional information or assistance from your physician, prior to your first fill.

for Individual and Employer Based Health Plans:

Download PDF

for Cox Self-Funded Health Plan:

Download PDF

 

Preferred Drug List

Download our Preferred Drug List for a guide on identifying preferred brand-name medicines within select therapeutic categories.

for Individual and Employer Based Health Plans:

Download PDF

Maintenance Medications List

Download our prescription maintenance medication list to learn which medications are available at a 90-day supply through EnvisionRx participating retail pharmacies or through your mail service program.

 
 

Generic vs. Name Brand

With prescriptions, you have the choice between generic and name brand drugs. Some plans offer better coverage for generic drugs, whereas others offer coinsurance, copayments or coverage that only applies after your deductible is met. You’ll want to evaluate at what level your prescriptions are covered, and how expensive they are, to determine if you need better coverage for prescriptions.

Generic medications work like the equivalent brand name drug in dosage, strength, performance and use. All generic medications are reviewed and approved by the Food and Drug Administration to perform in the same manner. Please discuss with your Physician what Generic alternatives may be available to start saving money on your out of pocket prescription costs.

Ways to Save Money on Your Prescriptions

Mail Order Savings

If you are taking maintenance medication such as blood pressure medicine, you may want to consider using our mail order service for additional savings. You get:

  • 90-day supply
  • 2.5 times your copayment instead of 3
  • Convenience of your medication being delivered to your home
Generic Utilization

There are numerous generic and over-the-counter (OTC) medications available for you to buy that are approved to help treat common healthcare conditions.

Download PDF
Over-the-Counter (OTC) Medication Benefits

Using an over-the-counter medicine will not only save you money, but you also have more options to find the best medicine for you.

Download PDF
Glucometer OneTouch

Effective January 1, 2016, OneTouch is Now a Preferred Diabetes Testing Product on EnvisionRX.

Download PDF
Envision Mobile App

Manage your prescription benefits using the EnvisionRx free app on your mobile device.

Download PDF

Prescription Forms

Prescription Prior Authorization

This form is used by a physician to request authorization of a particular prescription medication.

Download PDF
Designation of Personal Representative

This form is used to designate those people allowed to receive information from Envision about your medical information and prescription claims.

Download PDF
Formulary Prescription Exception Form

Certain requests for coverage require review with the prescribing physician.

Download PDF
Prescription Mail Order Form

This is the form used to request mail order service for prescription medications.

Download PDF
Quantity Limit Exception Request

This form is used by a physician to request authorization for a quantity above the allowed limit on certain medications.

Download PDF
Prescription Appeal Form

This form is used for prescription appeals.

Download PDF
Prescription Claim Form

This form is used if a member needs to submit a prescription claim.

Download PDF
Prescription Claim for Compound Medications

This form is used if a member needs to submit a prescription claim for compounded medications.

Download PDF