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Drug Formulary


The Oxford Three-Tier Prescription Drug Benefit

Please note:
The following information regarding the Three-Tier Prescription Drug Benefit currently applies to all Members enrolled in groups who have elected this pharmacy benefit. In addition, as of January 1, 2001, certain Medicare plans also incorporate the Three-Tier Drug Benefit. If you do not know whether you are enrolled in a Three-Tier Prescription Drug Benefit, or if you have questions about your pharmacy benefit or copay structure, please contact Pharmacy Customer Service at 800-905-0201.

Choice has always been an important part of Oxford's healthcare coverage, and that has extended to our prescription benefits. In addition to enjoying the ability to choose from a vast network of pharmacies that accept Oxford's coverage, our Members have the freedom of choice over whether to pay less for a Generic drug or more for a Brand name drug.

Over the past few years, the consumption of prescription drugs - and the costs associated with those drugs -- has been increasing at double-digit levels. In fact, the costs have far outpaced the rate of inflation, due to advances in technology, development costs, and increased consumer demand. In response to these rising costs, Oxford has created a Three-Tier Prescription Drug Benefit. This benefit encourages medically appropriate and economical use of drugs while allowing you to continue to receive the prescription coverage you have come to expect as an Oxford Member.

Making the Most of Your Pharmacy Coverage
The Three-Tier Prescription Drug Benefit offers three different copay levels, which will vary according to the tier of drug you and your physician choose:

TIER 1: Generic DrugsLowest
TIER 2: Preferred Brand DrugsMiddle
TIER 3: Non-preferred Brand Name DrugsHighest

As you would with any other important purchase, Oxford recommends that you consider the cost of alternatives available to you when you decide to purchase a medication. You can almost always choose a Brand Name drug and pay the highest copay. In many cases, though, you can also choose a Preferred brand or Generic drug, pay a lower copay, and take comfort in knowing that the FDA has approved the medication for treating your condition.

Talking With Your Physician
Members are encouraged to discuss the various drug choices with their physician before he or she writes a prescription. Oxford participating physicians have access to the list of Preferred brand drugs, which maybe substituted for more expensive Non-Preferred brand name drugs. Members can also review the list of Preferred brand drugs by visiting our "Prescription Drug List". With the Three-Tier Prescription Drug Benefit, Members have the opportunity to work with their physician to access the medically appropriate treatment at the best price.

For more information, click here for commonly asked questions.

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