Capital Health Plan utilizes a Pharmacy Benefit company called Prime Therapeutics to administer our pharmacy benefits. Members can register at the Prime web-site (https://www.myprimetools.com) to find out more information about their specific medications (including refill history and cost), general information on medications (side effects, storage concerns, and drug interactions), and the benefit of using generics over brand name medications.
Capital Health Plan contracts with over 50,000 pharmacies nationwide and encourages the use of generics as the first-line of treatment. Generic medications are the lowest-cost options to our members and are available at a Tier 1 copay. Members should talk with their doctor to see if a generic is available to treat their medical condition. If a generic is not available, a preferred brand name medication can be used, and will have a Tier 2 copay. Any brand name not designated as preferred (P) on our 2014 Commercial Formulary (pdf 858.14 kB) is considered non-preferred and may result in a member's highest pharmacy copay.