Pharmacy
Your prescription benefits cover prescription drugs, injectable medications, insulin and diabetic test supplies. When visiting a participating pharmacy,
be sure to present your ID card to the pharmacist. You will only be required to pay the appropriate copay for each 30-day supply.
Some drugs may require prior authorization or be subject to quantity limits (see Prior Authorization Page). It is very important to make sure that prior approval is received before going to the Pharmacy.
Prescription drug copayments are limited to $2,500 per person per benefit period. After the $2,500 maximum is reached, the health benefit plan pays 100 percent of allowed prescription drug charges per benefit period. All copays including specialty and any cost difference paid for brand drugs when a generic equivalent is available are applied to the $2500 maximum.
Certain self-administered specialty medications are excluded from the Plan's medical benefit, but are covered under the prescription drug benefit. To determine whether a self-administered specialty drug is covered as a prescription drug benefit, please review this list.
This list is subject to change. As new self-administered medications become available, they will be added to this list as quickly as possible and excluded from the medical benefit.
For questions regarding your prescription benefit, please call Medco Customer Service at 1-800-336-5933, or visit Medco's Web site.
For more information on your prescription drug benefits, please visit the following links:
- $10 Generic
- $35 Preferred Brand where generic is not available
- $55 Non-Preferred Brand where generic is not available
- Brand name drug where generic is available
- Members must pay the generic copay plus the difference between the Plan's cost of the brand name drug and the Plan's cost of the generic drug
- Specialty drugs
- Members must pay 25% coinsurance up to $100 for each 30-day supply (list of specialty medications)
Some drugs may require prior authorization or be subject to quantity limits (see Prior Authorization Page). It is very important to make sure that prior approval is received before going to the Pharmacy.
Prescription drug copayments are limited to $2,500 per person per benefit period. After the $2,500 maximum is reached, the health benefit plan pays 100 percent of allowed prescription drug charges per benefit period. All copays including specialty and any cost difference paid for brand drugs when a generic equivalent is available are applied to the $2500 maximum.
Certain self-administered specialty medications are excluded from the Plan's medical benefit, but are covered under the prescription drug benefit. To determine whether a self-administered specialty drug is covered as a prescription drug benefit, please review this list.
This list is subject to change. As new self-administered medications become available, they will be added to this list as quickly as possible and excluded from the medical benefit.
For questions regarding your prescription benefit, please call Medco Customer Service at 1-800-336-5933, or visit Medco's Web site.
For more information on your prescription drug benefits, please visit the following links:
