Understanding Your Prescription Drug Coverage

Sign in at Bravenhealth.com to See Your Drug Benefits

Prime Therapeutics (Prime) partners with Braven Health to manage your prescription drug benefits. You just log in to your Braven member account and click on the Prescriptions tab in the Benefits and Coverage section. From there you click on “Go to Prime Therapeutics” to see all your benefits.

Once online, you can:

• See which medicines are covered
• Find an in-network pharmacy
• View your prescription history, including costs
• Learn more about your medicines
• Download plan documents and more

You can also sign up to have your prescriptions delivered through one of our home-delivery pharmacies.

Understand Prescription Drug Tiers

Every drug on Braven Health’s list of covered medicines falls under one of six cost-sharing levels or tiers. The different tiers and the type of medicines are:

• Tier 1: preferred generic
• Tier 2: generic
• Tier 3: preferred brand
• Tier 4: non-preferred drug (may include some generic drugs)
• Tier 5: specialty tier
• Tier 6: select care drugs ($0 for covered medicines)

See if Your Medicines Have Any Special Requirements

Some medicines have special requirements, which are shown on your plan's list of covered medicines. If your prescription has a special requirement, talk to your doctor, who may choose a different drug or ask your plan to approve your current medicine. The special requirements include:

• Prior authorization - approval is needed before a medicine will be covered. If your prescription needs prior approval, talk to your doctor about choosing a different drug. You can also ask for your current medicine to be approved.
• Step therapy - you may need to try a different medicine first. Some drugs aren't covered unless you try another FDA-approved drug first or your doctor submits an approval request to Prime.
• Quantity limits - limits how much medicine can be in each fill. Each prescription can only be filled for a specific amount: for example, 14 capsules for seven days. If your doctor thinks you need a larger supply, they must ask for approval from Prime.

Know Which Drug Payment Stage You’re In

Your coverage for Part D prescription medicines has four stages. How much you pay for your prescription medicines depends on each coverage stage.

• Stage 1 – yearly deductible: You pay the total cost of your medicines until you reach your pharmacy deductible amount. If your plan has no deductible, you will start in Stage 2.
• Stage 2 – initial coverage: In 2024, you pay a fixed copay or coinsurance in this stage until your year-to-date total drug costs reach $5,030. (Total drug costs are what you pay plus what your plan pays.)
• Stage 3 – coverage gap or "donut hole": You’ll pay more for your medicine because there’s a temporary limit on your plan's payments. In 2024, you’ll pay 25% of the cost of your medicine until your total out-of-pocket costs reach $8,000. Medicare sets this amount.
• Stage 4 – catastrophic: Once you reach $8,000 in total out-of-pocket costs for the rest of the year, your plan will pay the total cost of your medicines and you pay nothing, until December 31. On January 1, you'll return to Stage 1.

Please note: Whenever you fill a prescription, you’ll receive an Explanation of Benefits, which shows which prescription drug stage you’re in.

Questions About Your Braven Health Prescription Drug Benefits?

Call Pharmacy Member Services at 1-855-457-0222 (TTY 711), 24 hours a day, seven days a week.