Pharmacy Benefit and Formulary Information
HIRSP policyholders have access to high quality prescription drug benefits at a reasonable cost. In this area you will find information about the drug formulary, which is a list of covered or reimbursable drugs approved for use by HIRSP policyholders. You can also find information on how to receive prior authorization for certain prescriptions, as well as drug claim forms.
Currently, HIRSP policyholders are required to pay either a $10 or a $30 co-payment depending on the prescription drug they are purchasing. In most cases, $10 co-payments are required for generic or low-cost brand name drugs, while $30 co-payments are required for most brand name drugs and some high-cost generic drugs. Please note that HIRSP Medicare Supplement policyholders must use their Medicare Part-D formulary and NOT the HIRSP formulary when purchasing medications. Therefore, all generic medications on your Part-D formulary will be charged a $10 co-payment and all brand name drugs on your Part-D formulary will be charged a $30 co-payment.
The following are pharmacy forms and information for HIRSP policyholders.
Quick Links
- Mail Order *
- Navitus Pharmacy Directory *
- Preferred Drug List (Formulary) *
- Additional information about formulary *
Forms and Notifications
- Alert: ETHEX Corporation has issued a recall on a single lot of morphine sulfate 60 mg extended release tablets (Lot No. 91762)
- Actavis Totowa LLC has issued a recall of all DigitekŪ (digoxin) tablets for oral use
- See if a Lower Cost Tier 1 Alternative is Right for You
- Lower Cost Rx Alternatives
- Generic Alternatives
- Fexofenadine and Allegra-D will no longer be covered
- RxCents Tablet Splitting Program
- Duragesic, sold by PriCara, voluntarily recalled
- HIRSP Expanded Pharmacy Networks
- HIRSP Prescription Drug Claim Form
- Prior Authorization Form for Compounded Drugs
- Commonly Prescribed Specialty Pharmacy Products
- Navitus SpecialtyRx Notice
