What is the HNE Performance Formulary?
The HNE Performance Formulary is our innovative, 2-Tier pharmacy benefit. Tier 1 includes all generic drugs. Tier 2 includes specific brand name drugs carefully selected based on clinical efficacy and cost efficiency.  When we designed this formulary, we made sure that at least one medication is available to treat each disease state.

• 70% of the prescription drugs HNE members purchase today are already available as generics.
• The HNE Performance Formulary includes all therapeutic classes

What about brand name drugs that are not on the HNE Performance Formulary?
If a medication is not listed in the HNE Performance Formulary, members can get the medication at a participating pharmacy for the HNE drug discount rate. The discount rate varies by the particular drug, but in general is between 10% and 30% of the retail cost.

Exclusions and Limitations
The HNE Performance Formulary also includes some drug specific exclusions and limitations. These are described below in general terms. For information specific to your plan, you can log in to HNEDirect where you can get a copy of your member agreement. Or, contact HNE Member Services.

• Exclusions: HNE does not cover certain drugs, or drugs to treat certain conditions. For example, drugs for cosmetic purposes are not covered.
• Prior Approval: HNE must authorize coverage before you get certain drugs.
  
• Quantity Limits: HNE may place limits the amount of a drug that you can get for each Copay, or the medical conditions for which a covered drug may be prescribed.
• Step Therapy: If a drug is in this program, it means there are other drugs available.  These other drugs are called “first line” drugs.  They are usually less costly.  The first line drugs treat the same problem as the Step Therapy drug.  The first line drugs are drugs found to match the clinical effect of the Step Therapy drugs.  Before HNE will cover a step therapy drug, you have to try one (or sometimes more) of the first line drug(s). If the first line therapy does not work for you, HNE will cover the Step Therapy drug.

HNE Performance Formulary List

HNE Performance Formulary Prior Approval Drugs

HNE Performance Formulary Quantity Limitation Drug List

HNE Performance Formulary Step Therapy List

HNE Performance Formulary Excluded Drug List