A drug formulary helps you understand what drugs are covered by your pharmacy benefit and how much you will pay. This guide will help you review Navitus Health Solution’s formulary for your pharmacy benefit in 2023.

The formulary lists medications in two ways:

  • The first section shows medications in alphabetical order.
  • The second section shows all the same medications listed by drug class or category.

You can also search for a medication name using the magnifying glass search icon or CTRL + F on your keyboard.

Below we explain what each column of the formulary means, starting on the left.

Drug Name

This is the name of the drug and other identifying information.

Special code

Drugs that include letters under the column heading “Special Code” have special considerations you need to know. Here are the meanings of some of the most common codes. (You may also refer to the key at the bottom of every page on the formulary that includes these and additional codes.)

  • MSP, SP or LD = Specialty drug
    • When you have a chronic or complex health condition, your prescriber may recommend a specialty drug that requires special handling, monitoring or approval. Specialty drugs are indicated by the special code MSP, SP or LD and tier 1, 2 or 3. These drugs can be expensive, but there may still be the opportunity to save money if you select a generic or preferred brand over a nonpreferred brand.
  • PA = Prior authorization 
    • If a drug includes (PA) in the special code column, that means your provider will need to submit additional information to Navitus for review before it can be filled to ensure it is the right medication for your situation.
  • QL = Quantity limits
    • Some medications are limited in the number of doses you can receive at one time. If your medication has a quantity limit, it will have (QL) in the special code column. 
  • ST = Step Therapy
    • This medication requires trial of a first-line medication before trying this drug. Your prescriber or pharmacist can give you more information.
  • RS = Restricted to a specialist
    • This means this medication must be prescribed by a specialist or specific type of provider.
  • INF = Infertility
    • These are medications used to treat infertility.

Tier

The pharmacy benefit chart shows medication types and the cost for drugs in different tiers based on generic, preferred brand and nonpreferred brand categories. In the column labeled “Tier” each drug will include one or more of the codes/abbreviations in the table below.

Tier

What it means

1

Generic drug, the most cost-effective option for many medications. Generic drugs have been tested and found to be as effective or more effective than their brand-name counterparts.

2

Preferred brand medications, determined to be effective as well as cost-efficient.

3

Nonpreferred brand-name drugs, the highest cost option.

1 combined with SP or LD

Generic specialty medication, the most cost-effective option.

2 combined with SP or LD

Preferred brand specialty medication.

3 combined with SP or LD

Nonpreferred brand specialty medication.

NC

Not covered. This drug is not covered by your plan’s formulary. You may want to talk with your prescriber about an alternative medication.

50%

50% coinsurance.

Category

Every drug indicates a drug class or category. If one drug is not covered or is a nonpreferred brand, you may find a generic or preferred brand drug that has the same or better clinical outcome in the same category.

In the second half of the formulary list, medications are grouped by category, making it easier to find similar medications.