Prescription Drug Benefits

Members and Non-Medicare Retirees
Members and non-Medicare retirees with a Preferred Provider (PPB) Plan are covered by the following prescription drug benefits:

High-Performance Preferred Drug List (Plans A, B and C)
High-Performance Preventative Drug List (Plan C)
High-Performance Formulary Tier Listing
Retail Maintenance Network
Maintenance Medications List
Common Specialty Medications
Case Managed Drugs
Prior Authorizations/Drugs with Special Limitations

Prescription Drug Claim Form
Prescription Drug Claim Form (foreign)


Medicare Retirees
Medicare retirees receive prescription drug benefits through one of two plans:

Medicare Advantage Plan (Humana)
Special Medicare Plan (PEIA)