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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

October 2014

Value Formulary Offered in 2015 

Harvard Pilgrim will be offering a new formulary option for employer groups next year. The Value formulary is a closed formulary that will be offered in addition to our current open formulary (the Premium formulary). Harvard Pilgrim’s Value formulary balances cost-effectiveness with benefits, and was developed to include virtually all drug classes, with affordable alternatives available in each class.

Recognizing Value formulary members
The Value formulary will become available on Jan. 1, 2015, and while many small group and individual plans will move to it automatically, large groups and self-insured plans can choose either the Value or Premium formulary. You will be able to distinguish which formulary applies for your Harvard Pilgrim patients by their ID cards. The ID cards of members who are on a Value formulary plan will include the word “Value” ahead of the prescription drug cost sharing information. If a member is on the Premium formulary, the ID card will either not have any designation next to the prescription drug cost sharing information (existing cards) or will read “Premium” (if a new ID card was issued).

Formulary overview
The Value formulary will include most generic drugs and single-source brand-name drugs (i.e., those without generic equivalents), while multi-source brand name drugs are excluded. However, there are some exceptions, including the following covered multi-source brand name drugs: Dilantin, Tegretol XR, Synthroid, Levothroid, and Unithroid. Harvard Pilgrim will offer Value 4-tier and Value 5-tier formulary plan designs.

Value 4-Tier 

Value 5-Tier

Tier 1 

Generics only

Lower-cost generics

Tier 2  Preferred brands
(some high-cost generics)

Higher-cost generics

Tier 3  Non-preferred brands and preferred specialty
(some higher-cost generics)
Preferred brands
(some high-cost generics)
Tier 4  Non-preferred specialty drugs
(including very high-cost brand and generic drugs)
Non-preferred brands and preferred specialty
(some higher-cost generics)
Tier 5  N/A Non-preferred specialty drugs
(including very high-cost brand and generic drugs)

To aid members and providers in understanding which commonly used medications are excluded from the Value formulary and what the covered alternatives are, Harvard Pilgrim has developed a 2015 Value Formulary Non-Covered Drug List (Abridged). The complete searchable formulary will be available in the pharmacy section of Harvard Pilgrim’s provider website by November.

Changes to the Value formulary
Harvard Pilgrim will regularly review and update the drug list as new drugs and drug information become available. As a result, the tier placement of drugs may change at any time. Drugs that are new-to-market may be excluded pending review by Harvard Pilgrim’s Pharmacy and Therapeutics committee to determine their placement in the Value formulary.

If you have any questions or feedback about the Value formulary, contact Pharmacy Services at pharmacy_services@harvardpilgrim.org. Future issues of Network Matters will also include additional information on the Value formulary.

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Eric H. Schultz,
President and Chief Executive Officer

Richard Weisblatt PhD,
Senior Vice President, Provider Network

Annmarie Dadoly,

Kristin Edmonston,
Production Coordinator