Prescription Drug Lists

You have access to a wide range of prescription medications. Your provider can use our prescription drug lists (PDLs) to prescribe effective and affordable medications for you.

• 3-Tier Advantage Prescription Drug List (Large Groups) (PDF) (employers with 51+ employees)
• 4-Tier Advantage Prescription Drug List (Large Groups) (PDF) (employers with 51+ employees)
• 4-Tier Small Group Plan Prescription Drug List (PDF) (employers with 2-50 employees)
• 4-Tier Individual Plan Prescription Drug List
• 4-Tier HPN Balance Prescription Drug List (PDF)
• 4-Tier Essential Plan Prescription Drug List (PDF)

• Advantage 3-Tier
• Advantage 4-Tier
• NV Individual 4-Tier
• Essential 4-Tier
• Balance 4-Tier
• Small Group 4-Tier

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.

• 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 prescription 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 prescription drug list, please call Member Services toll-free at 1-800-777-1840.