Pharmacy Information
Members with PAI’s pharmacy benefit coverage with OptumRx can use the drug cost estimator tool or use the pharmacy locator tool for broad network or view the drug lists below. For the most accurate and up-to-date information for all members, log into My Benefits ManagerSM, then PAI Pharmacy Benefits.
- Lowest Net Cost Formulary
Lowest Net Cost Formulary - A formulary is a list of prescription medications that are covered by your plan. The drugs on this list are chosen for their clinical value and cost-effectiveness by an independent panel of physicians and pharmacists.
- Drug Management Programs
Quantity Management - This program limits the amount we cover for certain drugs. We provide medical necessity exceptions for some of these limits when you request and receive prior authorization for them.
Step Therapy - Step therapy requires members to try cost-effective “First Choice” medications before trying (or “stepping up to”) more expensive “Second Choice” medications. We provide medical necessity exceptions when you request and receive prior authorization for them
- Specialty Medical Medications
PAI requires prior authorization for some specialty drugs billed under the medical benefit. Also, the medical benefit does not cover certain self-administered specialty drugs.
Medical Drug List - View this list to find out which medical specialty drugs require prior authorization under the Specialty Medical Benefit Management (SMBM) program.
Self-Administered Specialty Drugs - View this list to view self-administered specialty drugs.