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UNITE HERE Staff Plan Members!

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Copays

Find a Pharmacy

  What you pay
When you use a network or mail order pharmacy
Certain preventive drugs/supplies $0
Generic drugs $15 copay
Preferred brand name drugs $25 copay
Non-preferred brand name drugs $35 copay
Mail order $10 copay
Specialty brand or biosimilar drugs 25% coinsurance ($35 max copay)
effective 6/1
Existing out-of-pocket limits continue to apply.

 

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: (866) 686-0003

In Network

Out of Network

 Albertsons
Safeway
RiteAid/Brooks/Eckerd
Walgreens
Shoprite
Pathmark/Waldbaums
Kmart
Supervalu
Martins/Giant/Stop & Shop
Ralph's
Tom Thumb
Kroger/Fred Meyer/Fry's/King Soopers
Randalls
United Drug
Winn Dixie
Vons/Pavilion
Costco
CVS
CVS/Longs
Wal-Mart
Certain independent local pharmacies

 

Remember: Don't go out of network, you will pay 100% of the cost! 

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 Preferred and Non-Preferred Brand Name drugs before the prescription is picked up. If you need to take a drug that requires prior authorization, your doctor must call (877) 266-9991.
  • 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.
  • Quantity Limit Program. This is sometimes called “dispensing limits.”  There are certain prescription drugs that many providers prescribe at higher dosages than the FDA considers to be safe. Coverage for these prescription drugs will be limited to a 30-day supply.

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 (877) 266-9991.

Medications may be added to the Step Therapy list every January 1, and to the prior authorization list throughout the year. If your prescription is ever affected by this, 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: (877) 266-9991
  • We will help you with this transition process. If you are currently taking a Specialty drug, 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.