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CoverRx Application

Cost to participate
Participants will not pay monthly premiums to participate in CoverRx, but co-payments will be required for prescriptions based on the income guidelines. CoverRx provides the following benefits:
Affordable access to formulary with approximately 250 medications, mostly generic
Includes insulin, diabetic supplies and mental health drugs
Up to five prescriptions per month (insulin and diabetic supplies will not count against the monthly limit)
Discount for non-covered drugs; no prior authorization program for drugs off formulary
CoverRx is not insurance and will not cover doctor's visits or hospitalizations

Drug Category Below FPL FPL to 149% FPL 150% to 250% FPL
Generics: 30-day supply $3 $5 $8
Generics: 90-day supply* $3 $10 $16
Brand/Insulin/Diabetic Supplies: 30-day supply or up to covered limit $5 $8 $12
Drugs not on the CoverRx list and all prescriptions above the five prescription per month limit Lesser of Discount, MAC or U&C**

A 90-day supply is not available for covered brand drugs, covered insulin or covered diabetic supplies.
*90-day supplies available only through mail order and select retail pharmacies that have chosen to participate.
**Discount means a price reduction offered to participants for certain prescriptions.
**MAC means the maximum allowable cost of a drug and is a drug reimbursement policy.
**U&C means usual and customary charges, which are amounts charged by healthcare providers.

CoverRx Generic Equivalents for Brand Drugs
CoverRx provides the generic equivalent of the following popular brand drugs.

Cholesterol/Heart/Blood Pressure
Zocor® (simvastatin)
Coreg® (carvedilol)
Norvasc® (amlodipine)
Prinivil, Zestril® (lisinopril)
Toprol XL® (metoprolol succinate extended-release)
Pravachol® (pravastatin)
Inderal® (propranolol)

Anxiety/Depression/Anticonvulsants
Paxil® (paroxetine)
Zoloft® (sertraline)
Wellbutrin XL® (bupropion XL)
Neurontin® (gabapentin)
Celexa® (citalopram)

Asthma
Flonase® (fluticasone)
ProAir HFA®*

Diabetes
Glucophage® (metformin)
Lantus®*
Novolin®*
NovoLog®*

Gastroesophageal Reflux
Prilosec® (omeprazole)

*Covered brand drug
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Cover Tennessee | 312 Rosa L. Parks Avenue | Suite 2600 | Nashville, TN 37243 | 1.866.CoverTN