The Plan pays for covered prescription drugs provided at either retail or mail order pharmacies. You must comply with the program rules regarding generic/name brand, preauthorization when required, and using the mail order pharmacy as indicated in order to obtain maximum benefits.
There are 5 places you can get your prescriptions:
- Participating Retail Pharmacy: This is for prescriptions expected to run for 34 days or less. Use your ID card and pay only the copayment shown below.
- Preferred Participating Mail Order Pharmacy: This is for maintenance prescriptions (those over 34 days). You can obtain a 90-day prescription by completing the prescription order form and mailing it in the pre-addressed envelopes. You will receive your medications via U.S. Mail.
- Out-of-network Pharmacies: These are for participants who live in areas not served by a Participating Pharmacy. Reimbursement is at 50%.
- Non-Participating Pharmacy: If you choose to purchase your drugs here, you will have to pay a 100% copayment
If you or your physician requests that your prescription be filled with a brand name when a generic equivalent is available, you will be responsible for the difference in cost in addition to the brand-name copayment shown below.
For prescriptions which will be taken for longer than 34 days, it is highly recommended that you order these prescriptions through the mail order program. When the drug is initially prescribed for your use obtain 2 prescriptions from your doctor, one to be filled at the retail pharmacy (the first 30 days) and the second to be filled by mail order.
Generic Preferred Brand Name Non-Preferred Brand Name Specialty Drug Participating or Approved Retail Pharmacy 20% 35% 50% No Reimbursement Mail Order The lesser of 20% of the cost of the drug or $20 The lesser of 35% of the cost of the drug or $50 The lesser of 50% of the cost of the drug or $100 $100 Non-Participating Pharmacy
– No Coverage – You Pay Full Cost
100% 100% 100% 100%
To Find Participating Pharmacies