2022 Nebraska Health Plans Portfolio (IFB)

Prescription Drug Coverage

Our list of covered drugs To help keep your costs low, our plans cover safe and effective drugs on Medica's List of Covered Drugs. Your cost will depend on which tier your drug belongs to.

$

TIER 1

Generic

$$

TIER 2

Preferred brand

$$$

TIER 3

Non-preferred brand

$$$$

TIER 4

Specialty

Insulin coverage You'll pay no more than $25 for insulin per prescription unit when you fill it at a network pharmacy.

90-day refill options Your doctor can prescribe 90-day supplies of certain medications. Talk to your doctor about this option for you. Once prescribed, pick it up at a network pharmacy – or have it sent through our mail- order pharmacy at no extra cost when you use standard shipping.

Search the drug list or find a pharmacy To apply your benefits to a prescription on our drug list, you need to visit a network pharmacy. Our network includes more than 68,000 pharmacies nationwide, including most major chains and thousands of independent pharmacies.

See what drugs are covered or find a network pharmacy by using Medica.com/NEPlans22.

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