Copays
Find a Pharmacy
| Prescription drug feature | Silver Plus and Gold Plus |
|---|---|
| Generic | $5 copay per prescription |
| Brand name on the formulary | $30 copay per prescription |
| Brand name diabetes oral medications, insulin and supplies on the formulary | $15 copay per prescription |
| Generic specialty or biosimilar drugs on the formulary | $5 copay per prescription |
| Brand name specialty or biosimilar drugs on the formulary | 25% coinsurance |
| Mail order | Same copay as above for 60-day supply |
View your pharmacy book to find out about your pharmacy benefits.
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 |
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:
- Contact One Touch:
- Visit www.OneTouch.orderpoints.com or call (888) 883-7091
- Use order code: 739WDRX01
- Contact FreeStyle (by Abbott):
- Visit www.ChooseFreeStyle.com or call (866) 224-8892
- Use order code: U2L65MBU
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 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.
- We work with Welldyne Specialty Pharmacy 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 (844) 857-5772 to learn how to transition to Welldyne Specialty Pharmacy.
- 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.