Some covered drugs may have additional requirements or limits on coverage. These requirements and limits may include:
Prior Authorization: Nascentia Health Plus requires you or your physician to get prior authorization for certain drugs. This means that you will need to get approval from Nascentia Health Plus before you fill your prescriptions. If you don’t get approval, Nascentia Health Plus may not cover the drug.
Quantity Limits: For certain drugs, Nascentia Health Plus limits the amount of the drug that Nascentia Health Plus will cover. For example, Nascentia Health Plus provides 60 or 90 pills per prescription (depending on the strength of the drug), for oxycodone hcl. This may be in addition to a standard one-month or three-month supply.
Step Therapy: In some cases, Nascentia Health Plus requires you to first try certain drugs to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, Nascentia Health Plus may not cover Drug B unless you try Drug A first. If Drug A does not work for you, then Nascentia Health Plus will then cover Drug B.
Generic Drugs: Nascentia Health Plus covers both brand name drugs and generic drugs. A generic drug is approved by the FDA as having the same active ingredient as the brand name drug. Generally, generic drugs cost less than brand name drugs.