Pharmacy Coverage for MDwise Marketplace

A searchable list of drugs and participating pharmacies is available by selecting the links below:
In order to provide high quality, affordable prescription drug coverage for you and your family, MDwise Marketplace uses a company called MedImpact to ensure you get the most from your benefits. MedImpact manages a list of covered drugs called a formulary. This formulary may be different than your previous prescription coverage program. It is important that you understand what medications are covered and what it will mean for you and your family.

Medications are organized into five tiers:
 
  Status Definition
Tier 1 Tier 1 Drugs
Tier 2 Tier 2 Drugs
Tier 3 Tier 3 Drugs
Tier 4 Tier 4 Drugs
Tier 5 Tier 5 Drugs
Non-Formulary Non-Formulary

Each tier has a different copay or coinsurance requirement. Tier 1 has the lowest out-of-pocket cost. Tier 4 has the highest. Often medications that are listed on a higher tier have a therapeutic equivalent. A therapeutic equivalent is a drug that has essentially the same effect in the treatment of a condition as one or more other drugs. The therapeutic equivalent may have a lower copay. For example, if the drug you are currently taking is Tier 3, you could save money by working with your provider to find a therapeutically equivalent Tier 1 drug.

Certain medications or supplies listed as non-covered may be available if medical necessity is determined after clinical review. Please contact your prescribing doctor to request that your doctor submit a prior authorization request to MedImpact for non-covered medications or supplies. Prior authorization forms are available for your doctor on the pharmacy forms page.

The benefit plan that you selected when signing up for MDwise Marketplace determines the amount of copay for medications. The copay differs depending on the metal level and the tier. Please see the chart below for more information on your copay responsibility for each prescription tier based upon your benefit plan.
 

2017 Bronze Plans

Tier Bronze Basic Bronze Plus Bronze Plus
with Adult Vision
Tier 1 $70 $55 $55
Tier 2 $140 $110 $110
Tier 3 40% 40% 40%
Tier 4 40% 40% 40%
Tier 5 $0 $0 $0


2017 Silver Basic Plans

Tier

Silver

Basic

Silver

Basic 73

Silver

Basic 87

Silver 

Basic 94

Tier 1  $20 $15 $10 $10
Tier 2  $50 $25 $15 $15
Tier 3 15% 15% 10% 0%
Tier 4 15% 15% 10% 0%
Tier 5 $0 $0 $0 $0

2017 Silver Plus Plans
Tier

Silver

Plus

Silver

Plus 73

Silver

Plus 87

Silver 

Plus 94

Tier 1  $20 $15 $15 $10
Tier 2  $45 $40 $30 $15
Tier 3 15% 15% 10% 0%
Tier 4 15% 15% 10% 0%
Tier 5 $0 $0 $0 $0

2017 Silver Plus with Adult Vision
Tier

Silver Plus
With
Adult Vision

Silver

Plus 73 with 
Adult Vison

Silver

Plus 87 with
Adult Vison

Silver 

Plus 94 with 
Adult Vision

Tier 1  $20 $15 $15 $10
Tier 2  $45 $40 $30 $15
Tier 3 15% 15% 10% 0%
Tier 4 15% 15% 10% 0%
Tier 5 $0 $0 $0 $0

2017 Silver Coinsurance Plans
Tier

Silver
Coinsurance

Silver

Coinsurance
Plus 73

Silver
Coinsurance
Plus 87

Silver 

Coinsurance
Plus 94

Tier 1  $30 $20 $10 $5
Tier 2  $55 $45 $15 $10
Tier 3 15% 15% 10% 0%
Tier 4 15% 15% 10% 0%
Tier 5 $0 $0 $0 $0
 

2017 Gold Plans

Tier Gold Plus
with Adult Vision
Tier 1 $10
Tier 2 $35
Tier 3 10%
Tier 4 10%
Tier 5 $0


2017 Zero Cost Share Plans

Tier Zero Cost Share
Tier 1 $0
Tier 2 $0
Tier 3 0%
Tier 4 0%
Tier 5 $0