PAI's preferred pharmacy benefit manager is OptumRx, a pharmacy care services company that creates smarter health care connections to help more than 65 million Americans realize improved care, lower costs, and a better overall experience.
Excluded Drug List – Shows drugs that are excluded from coverage, as well as how to request a formulary exception.
Lowest Net Cost Formulary – Also referred to as the Preferred Drug List, applies to most of our benefit plans, with just a few exceptions.
Prior Authorization Drug List – Applies to prescription drugs that require prior authorization.
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.
Specialty Pharmacy Drug List – Features drugs that are used to treat complex or chronic medical conditions.
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.
A member's specific health plan determines which drug lists apply to them. Members who are not sure which drug lists apply to their plans can log into the Members page at paisc.com for personal information.