Ask Our Clinical Pharmacists
Our pharmacy management consultants are available to cover a broad range of topics. Please submit your question using our secure online prescriber and pharmacy drug information form. We will make every effort to answer your question as soon as possible, however, please allow 3 business days for a response.
Quantity Limits
We require quantity limits to help assure our members have access to safe and effective drug therapy and to protect against inappropriate use and waste. Search our online drug list to find out if a quantity limit applies to your medication or view our list of drugs with quantity limits.
The program does not apply to members under our Medicare D, Medicaid Managed Care and Child Health Plus plans.
Generic Advantage Program
The Generic Advantage Program applies to a list of brand name drugs that have FDA approved generic alternatives. Members pay the generic price co-payment/coinsurance amount plus the difference between the costly brand name medication and our price for the less expensive generic.
The program does not apply to members under our Medicare D, Medicaid Managed Care and Child Health Plus plans.
Prescription Drug Authorizations
To assure our members have access to safe, effective drug therapy, and to protect against inappropriate use and waste, prior authorization and step therapy are required on select prescription medications.
EPIC Program for Seniors
Elderly Pharmaceutical Insurance Coverage (EPIC) is a New York State program that helps seniors (65 and older) with out-of-pocket Medicare Part D drug plan costs. It works together with Medicare Advantage plans to pay Medicare Part D premiums or provides assistance by lowering deductibles.
Specialty Pharmacy Network
The Specialty Pharmacy Network helps to manage the rising cost of self-administered and office-administered medications by using specialty pharmacies that monitor and distribute these high cost medications.
Specialty Drug Split-Fill Program
The Specialty Drug Split-Fill Program allows you to try expensive medications that have serious side effects for a shorter time, confirming effectiveness and tolerance before Members pay for full 30-day supply. This minimizes unnecessary expenses and reduces medication waste.
Medication Therapy Management Program
The MTM program provides you with the information and tools to help you make educated health care decisions. Our Medication Therapy Management (MTM) program is designed for members with Medicare prescription drug coverage who have specific health and pharmacy needs. The MTM program is not a benefit.
Prescription Discount Card
Inside Rx® is a prescription drug discount program made available to Univera Healthcare commercial members that is designed to assist those who currently pay 100% out-of-pocket for certain medications outside of their employer's pharmacy benefit. Our goal is to continue to provide cost-saving solutions to minimize the financial burden to members, and we’re providing this as a value-add option for our commercial members to save additional money on their out-of-pocket prescriptions.
Inside Rx provides discounts on prescription medications to Univera Healthcare members. Inside Rx is not part of Univera Healthcare.
The Inside Rx card is not insurance and it cannot be combined with your insurance, copay cards or any other secondary payer. Before using the Inside Rx card, check your insurance benefit because it may provide greater savings than the Inside Rx card. Claims not covered by your benefit may be processed through the Inside Rx prescription drug discount card.
