Prescription Drug Lists (PDLs) for Fully Insured Commercial Plans (non-exchange)
The PDL includes brand and generic medications separated into cost levels called tiers. When selecting a medication, review the PDL to see if there is a Tier 1 option (lowest cost) to treat your condition. If your medication is in Tier 2, 3 or 4 (highest cost), you may pay more. In addition we are providing a sample of a plan design offered in your market. This includes high level detail of all benefits provided, including prescription drugs.
Small Group Plans
Fully Insured Health plans that have 2-50 employees
Large Group Plans
Fully Insured Health plans that have 51 or more employees
2022
2021
For additional information and definitions, refer to the Advantage Tier 4 Prescription Drug list found within the Connecticut drawer on the Prescription Drug Lists page.
2022
Summary of Benefits Coverage
2021
Summary of Benefits Coverage
*groups up to 99 employees
Need help in another language?
- Visit language assistance resources for help in different languages.
- Para servicio al cliente en español, por favor llame al 1-800-985-3859, TTY 711, o visite la página de asistencia de recursos de idiomas.
- 語言協助 / 不歧視通知