The eligibility and enrollment rules for the U

Retiree Health Care SPD Effective January 1, 2012
Formulary Drugs
The formulary is a list of commonly prescribed brand-name and generic drugs Medco has
designated as “preferred" based on the drug’s clinical effectiveness and opportunities to help
contain costs. You will usually receive the highest level of coverage when you use formulary
drugs. For these plans, the formulary used includes generics along with approximately one or
more brand-name drugs in a therapeutic category.
Formulary Status:
Generic = lowest cost drugs to U.S. Bank and retirees (generics)
Preferred = Moderate cost drugs to U.S. Bank and retirees (brand-name drugs on the formulary
drug list)
Non-Preferred = Highest cost drugs to U.S. Bank and retirees (brand-name drugs NOT on the
formulary drug list). Some drugs may be grouped together as Non-Preferred. Examples include
“preferred” Proton Pump Inhibitors (PPI) = Heartburn/acid reflux medications such as Nexium
and all compounded medications.
At times you may also see drugs referred to as Tiers. A tier is typically the
copayment/coinsurance level assigned to that drug as follows:
Tier 1 = usually generic drugs
Tier 2 = usually formulary (preferred) drugs
Tier 3* = usually non-preferred drugs
Tier 4* = some drug classes may be grouped into Tier 4 which include both preferred and nonpreferred
drugs (for example, PPI medications and compounded medications).
*Tier 3 and Tier 4 are both considered the highest copayment/coinsurance level.
Once enrolled, you may view the formulary (preferred) status of a medication at
www.medco.com.
Sometimes your doctor may prescribe a non-preferred medication for which either a formulary
(preferred) brand-name or generic alternative drug is available. If your doctor specifies that a
prescription be “dispensed as written” or “DAW”, the pharmacist may ask your doctor whether a
generic or an alternative formulary (preferred) drug might be appropriate for you. Only if your
doctor agrees, your prescription will be filled with the substituted or alternative drug. A
confirmation will be sent to you and your doctor explaining the change. Ask your doctor if you
have questions about a change in prescription. Your doctor always makes the final decision on
your medication, and you can always choose to keep the original prescription. Pharmacies will
dispense only the medication authorized by your doctor. NOTE: The Medco Pharmacy
(Medco’s mail order service) will automatically dispense a generic, unless your doctor
indicates “DAW” or “dispense as written” on the prescription. Other substitutions may be
made by the pharmacist after consulting with your doctor. Regardless of what your doctor
prescribes, you are responsible for the applicable copayment/coinsurance based on the
drug you receive. When applicable, if a brand-name drug is dispensed and a generic drug
is available, you will pay the brand coinsurance plus the cost difference between the brandname
and the generic per covered prescription.
Please remember that the price of prescription drugs can fluctuate, which may affect your cost
for the medication. In addition, drugs can be added to or removed from the formulary throughout
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