|Prescription Drug Benefits - What You Pay|
|Lifetime Maximum Benefit||$25,000 per person|
|Prescription Drug Benefits||Per Prescription|
|Formulary Prescription Drug Benefits at the UNITE HERE HEALTH – Health Center and free pharmacy locations — see page F-3 in your SPD (up to a 60-day supply)|
|Prescription Drugs (excluding select specialty, select biosimilar, and select brand drugs)||$0|
|Select Specialty and Select Biosimilar Drugs*||25%|
|Select Brand Drugs*||50%|
|Formulary Prescription Drug Benefits at Network Retail Pharmacies and Mail Order||Retail Pharmacy up to a 34-day supply||Mail Order Pharmacy up to a 60-day supply|
|Smoking Cessation Drugs and Supplies (including prescription generic over-the-counter products, generic products, and certain brand products)||$0|
|Generic and Some Brand Drugs||20%|
|Preferred and Non-Preferred Drugs (excluding select brand name drugs)||20%|
|Select Brand Name Drugs||$15|
|Select Specialty and Select Biosimilar Drugs*||Not covered||Generic||Brand|
|Non-Formulary Prescription Drugs and Supplies||Not covered, unless an exception is approved|
|* Current pharmacy benefit provider will actively manage and determine drugs in tier. Specialty drugs are only available through the specialty mail order pharmacy or the Atlantic City Health Center. However, effective January 1, 2022, the Fund may approve an exception allowing you to purchase drugs for the treatment of HIV/AIDS through a network retail pharmacy.|
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.
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: (844) 813-3860
Out of Network
Jogi Discount Pharmacy
Certain independent local pharmacies
Remember: Don't go out of network, you will pay 100% of the cost!