2024 Evidence of Coverage for UnitedHealthcare® Group Medicare Advantage PEBB Complete (PPO) Chapter 5: Using the plan’s coverage for Part D prescription drugs 148 · Approved by the Food and Drug Administration for the diagnosis or condition for which it is being prescribed. · -- or -- Supported by certain references, such as the American Hospital Formulary Service Drug Information and the DRUGDEX Information System. The Drug List includes brand name drugs and generic drugs. A brand name drug is a prescription drug that is sold under a trademarked name owned by the drug manufacturer. Brand name drugs that are more complex than typical drugs (for example, drugs that are based on a protein) are called biological products. On the drug list, when we refer to “drugs,” this could mean a drug or a biological product. A generic drug is a prescription drug that has the same active ingredients as the brand name drug. Generally, generics work just as well as the brand name drug and usually cost less. There are generic drug substitutes available for many brand name drugs. What is not on the Drug List? The plan does not cover all prescription drugs. · In some cases, the law does not allow any Medicare plan to cover certain types of drugs (for more information about this, see Section 7.1 in this chapter). · In other cases, we have decided not to include a particular drug on the Drug List. In some cases, you may be able to obtain a drug that is not on the drug list. For more information, please see Chapter 9. Section 3.2 There are 4 “cost-sharing tiers” for drugs on the Drug List Every drug on the plan’s Drug List is in one of 4 cost-sharing tiers. In general, the higher the cost- sharing tier, the higher your cost for the drug: Tier 1 – Preferred Generic - All covered generic drugs. In addition, Part D eligible generic drug compound medications are covered in Tier 1. Tier 2 – Preferred Brand - Many common brand name drugs, called preferred brands. Tier 3 – Non-preferred Drug - Non-preferred brand name drugs. In addition, Part D eligible compound medications are covered in Tier 3. Tier 4 – Specialty Tier - Unique and/or very high-cost brand drugs. To find out which cost-sharing tier your drug is in, look it up in the plan’s Drug List. The amount you pay for drugs in each cost-sharing tier is shown in Chapter 6 (What you pay for your Part D prescription drugs). Section 3.3 How can you find out if a specific drug is on the Drug List? You have three ways to find out: 1. Visit the plan’s website (retiree.uhc.com/wapebb) for the most current information. 2. Call Customer Service to find out if a particular drug is on the plan’s Drug List or to ask for a copy of the list.