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Copays

Find a Pharmacy

  Gold Plus Silver Plus
Generic $10 copay per prescription $10 copay per prescription
Brand Name $30 copay per prescription $30 copay per prescription
Specialty Biosimilar 25% coinsurance
($50 max per prescription)
25% coinsurance
($50 max per prescription)
Mail Order same copay for 60-day supply same copay for 60-day supply

 

View your pharmacy book to find out about your pharmacy benefits starting January 1, 2019.

Brand name drug with generic available

If you or your healthcare provider insist on a brand name drug when a generic equivalent is available, you must pay the generic copay plus the difference in cost between the brand and generic drug.

Example:

If the generic copay is $10, the brand name drug is $80 and the generic is $50, you will pay $40. $10 copay plus $30 difference in cost.

For questions about your drug benefits, call: (855) 405-FUND (3863)

In Network Out of Network
Walgreens
Albertsons
Costco
Duane Reade
Rite Aid/Brooks/Eckerd
Certain independent local pharmacies
And others...
CVS
CVS/Longs
CVS Specialty
Wal-Mart
Certain independent local pharmacies

 

Find your nearest network pharmacy here

Other Information

Formulary Lists

You can get diabetic supplies from any retail pharmacy that’s in the network or by mail order. If you need a new glucometer, get one for FREE:


 

These are programs your doctor MUST use:

  • Prior Authorization. Your doctor must request approval for all specialty and biosimilar drugs and some brand name drugs before the prescription is picked up. If you need to take a drug that requires prior authorization, your doctor must call (844) 484-4726.
  • Step Therapy. Before using some drugs that are very expensive, you and your doctor must try less expensive drugs that are proven to work just as well — sometimes they even have the same ingredients.
    • This saves you and your health Fund money and prevents waste.
    • If you need to take a drug that is considered overpriced, your doctor must get approval by calling: (844) 484-4726.
  • Quantity Limit Program. This is sometimes called “dispensing limits.” If you are receiving more than what is considered safe (by the U.S. Food and Drug Administration), your health fund will not pay for it.

These programs save you and your health fund money, keep you safe, and prevent abuse and fraud.

We know it is sometimes medically necessary to take a drug even if it is the more expensive option. In these situations, your doctor must get approval by calling (844) 484-4726.

Medications may be added to the Step Therapy list every January 1st, and to the prior authorization list throughout the year. If your prescription is ever affected by these updates, we will notify you before the change.

Specialty Drugs

These include drugs used to treat health conditions such as growth hormone deficiency, hepatitis C, immune deficiency, hemophilia, multiple sclerosis and rheumatoid arthritis.

  • We work with AllianceRx Walgreens Prime to get the best service and the best prices. If you need a specialty drug, you MUST get them through this specialty pharmacy. Your doctor MUST first get approval by calling: (855) 405-FUND (3863)
  • We will help you with this transition process. If you are currently taking a specialty drug that is on the Specialty Drug Formulary, have your doctor call us at (877) 647-5807 to learn how to transition to AllianceRx Walgreens Prime.
  • Because of an exciting new program we are using, you may pay less some months for your specialty drugs than the listed maximum copay—we will provide details when we contact you.

 

Mail order pharmacy program:

  • Your plan will send medicine straight to your mailbox and it costs less!
  • To enroll, call our Mail Order Pharmacy partner, WelldyneRx, at (844) 813-3860.