|Formulary Prescription Drug Benefits at Network Retail Pharmacies and Mail Order.
Remember, under Class II, this benefit is limited to preventive healthcare drugs and supplies.
|Prescription Drug Benefits—What You Pay (per prescription)||Retail Pharmacy up to a 34-day supply||Mail Order Pharmacy up to a 60-day supply|
|Preventive Healthcare Services Drugs||$0|
|Generic and Some Brand Drugs||$10|
|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. However, effective January 1, 2022, if you take specialty medications as part of your HIV treatment plan, you may be able to receive an exception to use your network retail pharmacy instead of the specialty 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
Martins/Giant/Stop & Shop
Kroger/Fred Meyer/Fry's/King Soopers
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.
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: