3-Tier Prescription Drug Program

"Tiers" refers to copayment levels of cost sharing by the member. Tier 1 is the lowest copayment amount, Tier 2 is intermediate and Tier 3 is the highest standard member copayment. Practitioners who select clinically appropriate drugs from Tier 1 and Tier 2 will be choosing cost-effective drugs for their patients who have their drug benefits administered through ConnectiCare and a Pharmacy Benefit Management Company.

The ConnectiCare Pharmacy Drug List is organized by sections. Each section contains groups of drugs titled by drug class. The ConnectiCare Pharmacy Drug List is set up to encourage the use of Tier 1 or Tier 2 drugs where appropriate. Over-the-counter (OTC) products, with the exception of insulin, glucose monitoring products, and those listed in your benefit materials, are not covered.

The drug list is separated by tiers or levels in the following manner:

Tier 1: Lowest member copayment: primarily generics

Tier 2: Intermediate member copayment: Some branded and generic drugs or supplies

Tier 3: Highest member copayment: Some branded and generic drugs or supplies

Important Note: Most of our members will pay additional cost beyond their copayment if they choose to use brand name drugs rather than generics when a generic equivalent is available.

Pharmacy and Therapeutics (P&T) Committee

The ConnectiCare Pharmacy and Therapeutics Committee evaluate new drugs, therapeutic categories, policies and procedures, and other activities that govern the terms of prescription drug coverage. Some of the material submitted for Committee review has been prepared by a Pharmacy Benefit Management Company and some is prepared independently by the ConnectiCare Pharmacy Department. The Committee is composed of local physicians representing many medical specialties, a local community pharmacist, ConnectiCare Medical Directors, the ConnectiCare Pharmacy Director and Manager, and a pharmacy consultant from a Pharmacy Benefit Management Company.

The actions of the ConnectiCare P&T Committee in placing drugs in a tier or changing the tier of an existing drug are communicated in the ConnectiCare member newsletter and on the ConnectiCare web site. Please see the ConnectiCare Drug List for the most up-to-date version of the List. To receive a copy of Drug List additions or deletions, call ConnectiCare at (800) 251-7722.

Product Selection Criteria

The ConnectiCare P&T Committee will consider all FDA approved drugs for inclusion in the Pharmacy Drug List. The evaluation includes a literature review and expert opinion may also be sought. Formal reviews are prepared which typically address the following information:

  • Safety
  • Efficacy
  • Cost
  • Comparison studies
  • Approved indications
  • Adverse effects
  • Contraindications
  • Pharmacokinetics
  • Patient compliance considerations
  • Medical outcome and pharmacoeconomic studies
  • When a new drug is considered for drug list inclusion, the P&T Committee will examine the drug relative to similar drugs currently on the drug list. In addition, entire therapeutic classes of drugs are periodically reviewed in an effort to continually promote the most clinically useful and cost-effective agents in a particular therapeutic class. This review process may result in drugs changing Tier status, which will result in a change in the memberís copayment for those drugs.

    Some drugs evaluated by the P&T Committee receive a 3rd Tier designation on the list. Since 3rd Tier drugs will cost members more in higher copayments, physicians are encouraged to prescribe drugs in Tier 1 and Tier 2 when appropriate.
    All the material in the ConnectiCare Pharmacy Drug List is provided as a reference for drug therapy selection. The final choice of specific drug selection for an individual patient rests solely with the prescriber.