What you pay when you use a network or mail order pharmacy |
|
---|---|
Certain preventive drugs/supplies | $0 |
Generic drugs on the formulary | $15 copay |
Brand name drugs on the formulary | $30 copay |
Drugs NOT on the formulary | Not Covered |
Specialty brand or biosimilar drugs |
Generic: $15 copay |
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: (844) 813-3860
In Network |
Out of Network |
View your list of network pharmacies | Wal-Mart Sam's Club Certain independent local pharmacies |
Remember: Don't go out of network, you will pay 100% of the cost!
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:
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) 813-3860.
Medications may be added to the Step Therapy and prior authorization lists 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.
Mail order pharmacy program: