NH Stride
Plan Selected: 2024 Harvard Pilgrim Health Care Stride HMO/HMO-POS formulary
Zip Code: 03101 (Manchester, NH)
Formulary: Drug is covered with no Utilization Management requirements
- Drug = Lisinopril
Validate coverage of the drug through the Prescription Drug List link
Results of Prescription Drug List search (sample – more results were found):
Select Coverage details to view all information on this drug
Since the drug is showing as covered with no Utilization Management requirement, go to the Drug Pricing Tool for the coverage/pricing
Drug Pricing Tool – select the plan, enter a specific pharmacy (optional) and the zip code. Hit Apply, then enter the drug name.
Results of Drug Pricing Tool search (sample – additional pharmacies were included in the results)
Pricing:
Formulary: Drug is covered with Utilization Management requirements
- Drug = Abelcet (requires Prior Authorization)
Validate coverage of the drug through the Prescription Drug List link
Results for Prescription Drug List – shows that the drug is covered on Tier 4 and requires Prior Authorization
Select Coverage Details to see all information associated with this drug
Since this drug is covered and has utilization management requirements, currently the Drug Pricing Tool will not provide accurate information for the coverage or price. Below are screenshots of what you would currently see if utilizing the Drug Pricing Tool for this drug.
Screenshot of Results page: 1st half of page (Drug Coverage)
Screenshot of results page: 2nd half of page (Drug Pricing)
Enhanced covered drug: Drug is excluded by Medicare, but being covered by the Plan
Validate coverage of the drug through the Prescription Drug List link
Results for Prescription Drug List – the 3 results show the enhanced covered drugs on Tier 2
Select Coverage details to display all information about the drug:
Since this an enhanced covered drug, currently the Drug Pricing Tool will not provide accurate information for the coverage or price.
As a reference, below is a list of the 2024 enhanced covered drugs. They can also be found in the 2024 Formulary booklet (PDF) on the Home page.
Non-Formulary: drug is not covered
- Drug: Xanax
Validate coverage of the drug through the Prescription Drug List link
Results: The generic versions of Xanax are shown first, then the brand shows as Non-Formulary. No additional search using the Drug Pricing Tool is needed.
