How to Use the Health New England Member Edition Formulary

The Formulary is divided into two sections: Generic Drugs (Tier 1) and Brand/Formulary Drugs (Tier 2). Each section is listed alphabetically.

To find out if a covered medication you are currently taking is part of the Formulary, follow these simple steps:

1. Look up the name of the medication you actually received in the Generic Drug (Tier 1) and Brand/Formulary Drug (Tier 2) sections.

2. If you find the medication listed under Generic Drugs (Tier 1), you pay the lowest copayment level. Please keep in mind that the Generic Drug (Tier 1) listing is representative only. There are hundreds of generic drug products available. If you think that your drug is available as a generic, please contact your local pharmacist.

3. If you find the medication listed under Brand/Formulary Drugs (Tier 2), there is usually no available generic equivalent and you pay the middle copayment level.

4. If you do not find the covered medication, then it is probably a Brand/Non-Formulary Drug (Tier 3), which is not a part of the Formulary.You will pay the highest copayment level for these drugs.  Please consult your doctor, to see if there are any formulary brand or generics that are right for you.

Other Important Information: Please be aware that once the generic equivalent is available, it will then move to Tier 3.

Massachusetts state law dictates dispensing of the generic equivalent unless otherwise indicated by the physician.

How does this effect me?

• Higher copay

• If you choose to continue on the brand name drug, a new prescription from your physician will need to reflect “Dispense as written.”

• Contact your physician if interested in discussing alternatives.

NOTE: The contents of this Formulary are subject to change at any time without member notification.