Preferred generic and brand name medications are available for a Tier I and Tier II copay. Non-preferred medications, as well as some medications not listed, are covered at a higher Tier III or Tier IV copay.
Medications are grouped together based on their therapeutic category (i.e., anti-infectives, cardiovascular, etc.) and then separated into drug classes (i.e., antidepressants, contraceptives, etc.). Each drug class has a designated section number (i.e., 1-A, 1-B, etc.) and is the reference point noted in the index. The generic or chemical name is listed to the left of the brand or trade name for each drug. Drugs with a generic equivalent available are labeled with an asterisk (*) before the common brand name. For example, Ampicillin is listed as *PRINCIPEN. This means PRINCIPEN is available as a generic and Ampicillin would be filled by the pharmacy. Drugs that are not available generically have the brand name listed in BOLD print. For example, Rivaroxaban is listed as XARELTO. This means there’s no generic for XARELTO and the brand name product will be given.
Abbreviations used in our PDLs:
1, 2, 3, 4 = tier level for the drug (1 = Tier I, 2 = Tier II, 3 = Tier III, 4 = Tier IV)
AL = Age Limitations
PA = Prior Authorization
QL = Quantity Limitations
SF = Split Fill Program
ST = Step Therapy
SP = Specialty Drug
To learn more about these programs, click here. Health Plan of Nevada’s preferred drug lists (PDLs) are developed by a committee of actively practicing primary care and specialty care providers, pharmacists, and other health care professionals. If you have any questions regarding the preferred drug list, please call Member Services toll-free at 1-800-777-1840.