Broker Broadcast
Select Designated Pharmacy Program
The Select Designated Pharmacy program guides members to save money on select high cost (non-specialty) medications with three easy options. Each option has a different saving potential, and the member can choose any option to receive network benefits.
Member Savings Potential
- GOOD: Move to mail and continue on current medication will result in a member monthly savings of $8.
- BETTER: Move to a lower tier drug and stay at the retail pharmacy results in a member monthly savings of $40.
- BEST: Move to the mail order pharmacy and move to lower tier drug will results member monthly savings of $42.
Note: Savings based on a $50 retail co-payment. Members on affected drugs who make no change would pay the full cost of the drug and file a paper claim for reimbursement, as a non-network benefit.
Members taking affected drugs are allowed two prescription refills ("grace fills") at their retail pharmacy before they must select a new option to receive network coverage.
- Letter explaining the program (after grace fill #1)
- Phone call explaining the program (after grace fill #1)
- Point-of-sale message, delivered by the pharmacist (after grace fills #1 and #2)
Affected Medications
There are currently 18 targeted medications (all in Tier 3) in the Select Designated Pharmacy program. These high cost medications are used to treat chronic conditions and are often included in “mandatory mail” programs.
| Therapeutic Class |
Medication(s) |
| Anticonvulsant / Nerve Pain |
Lyrica |
| Benign Prostatic Hyperplasia |
Avodart, Uroxatral |
| High Blood Pressure |
Atacand/Atacand HCT and Avalide/Avapro |
| Inflammatory Bowel Disease |
Asacol/Asacol HD* |
| Migraine (triptans) |
Amerge, Axert, Frova, Maxalt/Maxalt MLT and Zomig/Zomig ZMT |
| Overactive Bladder |
Toviaz, Detrol |
*Asacol HD will be added to the Select Designated Pharmacy program in cases where it cannot
be excluded.
For more information, please contact your TIE Customer Service Account Manager at (972) 991-6500.
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