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Prescription Drug Program

Participating Network Pharmacies

The health plan will pay only for generic drugs if available. If you choose the brand name drug instead of the generic medication, you will pay the generic co-payment plus the difference in cost between the brand name and generic medications, regardless of a doctor’s Dispense As Written (DAW) instructions. If you wish to receive a generic drug and there is a DAW, the pharmacy must call your doctor to get his or her permission before switching to the generic.

Mail Order Program - Optum RX

A mail-order program is available with HealthSelect and all HMO coverage. Through this program, up to a 90-day supply of a prescription can be obtained (3-month payment for 90-day supply).

Cost to Employee

A $50 deductible applies to each member per plan year (January 1 - December 31). After deductible is met, member will be charged the appropriate co-payment.

Table 1: Prescription Drug Cost to Employee

 

Tier 1

Tier 2

Tier 3

Participating retail non-maintenance $15
up to a 30-day supply
$35
up to a 30-day supply if generic is not available*
$60
up to a 30-day supply if generic is not available*
Participating retail maintenance $20
up to a 30-day supply
$45
up to a 30-day supply if generic is not available*
$75
up to a 30-day supply if generic is not available*
All carrier mail order programs $30
For 31-60 day supply

$45
For 61-90 day supply
$70
For 31-60 day supply if generic is not available*

$105
For 61-90 day supply if generic is not available*
$120
For 31-60 day supply if generic is not available*

$180
For 61-90 day supply if generic is not available*
HealthSelect Extended Days Supply (EDS) Pharmacy Network $30
For 31-60 day supply
$45
For 61-90 day supply
$70
For 31-60 day supply if generic is not available*

$105
For 61-90 day supply if generic is not available*
$120
For 31-60 day supply if generic is not available*

$180
For 61-90 day supply if generic is not available*

*If generic is available and you choose to buy the brand-name drug, you will pay the generic copay plus the cost difference between the brand-name and the generic drug.

Page updated: 09/29/2017