Prescription Drugs

Prescription Drugs Covered by IEHP Covered

Learn which prescription drugs are covered with your IEHP Covered (Covered California HMO) plan.

Covered service expenses and supplies for prescription drugs are limited to charges from a licensed pharmacy for:

• A covered formulary prescription drug or one that is prior authorized by IEHP.
• A drug that, under the applicable state law, may be dispensed only upon the written prescription of a medical practitioner in our network.

Formulary and Tiers

IEHP has a list of covered drugs called a formulary.  The formulary is updated and posted monthly, and you can find the formulary and updates on our website at iehp.org.

Certain covered drugs have restrictions such as Step Therapy (ST), Quantity Limits (QL), and or require a Prior Authorization (PA).

FDA approved generic drugs will be used in most situations, even when a brand-name drug is available.  If your drug is non-formulary, or has a restriction, Your doctor will need to submit a request to IEHP. The request can be approved if there is a documented medical need.  To see a full list and explanation of the pharmaceutical management procedures and restrictions, click on the links below.

To find a pharmacy near you, Click here to search for in-network pharmacies for IEHP Covered (Covered California HMO).

IEHP covers generic, brand name, and specialty drugs. You are responsible for a copayment or coinsurance for each drug filled at the pharmacy. The amount of your copayment or coinsurance depends on the drug category and/or Tier indicated on the Formulary (example: Tier 1, 2, 3, 4) and your benefit plan (for example: Silver or Bronze). Please refer to the "Schedule of Benefits" for pharmacy copayments, coinsurance, deductibles, and/or out-of-pocket limits that may apply.

Tier 1:  Most generic drugs and low-cost, preferred brand drugs.

Tier 2:  Non-preferred generic drugs, preferred brand drugs, or drugs recommended by the P&T Committee based on drug safety, efficacy, and cost.

Tier 3:  Non-preferred brand drugs; drugs recommended by the P&T Committee based on safety, efficacy, and cost; or drugs that generally have a preferred and often less costly therapeutic alternative at a lower tier.

Tier 4:  Drugs that are biologics; drugs that the FDA or drug manufacturer requires to be distributed by specialty pharmacies; drugs that require training or clinical monitoring for self-administration.

Mail Order Pharmacy

If you would like to use our mail order pharmacy for convenient free home delivery, please contact our mail order pharmacies.  Maintenance prescriptions are available up to 100-day supply.

Please Note:

If you would like to use our mail order pharmacy for convenient free home delivery, please contact our mail order pharmacies.  Maintenance prescriptions are available up to 100-day supply.

Changing to Birdi or SortPak for mail order is your choice. If you do not wish to use either of these pharmacies, then you can find a complete list of other pharmacies that are in our network at www.iehp.org.

For more information on this benefit, refer to the EOC and Schedule of Benefits.