Prescription Plan
All medical plan participants have prescription drug coverage based on their selected plan. A way to save money is by requesting generics and/or mail order options when available.
| Prescription Plan Features | PPO 90/10 & 80/20 Retail Rx |
PPO 90/10 & 80/20 Mail-Order Rx |
Simply Select Retail Rx |
Simply Select Mail Order Rx |
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|---|---|---|---|---|---|---|---|
| Annual Rx Deductible | $0 | $0 | $1,975 individual / $3,950 family (integrated with medical) |
$1,975 individual / $3,950 family (integrated with medical) | |||
| Generic Rx | $10 copay | $25 copay | $10 copay (after deductible) | $20 copay (after deductible) | |||
| Preferred Brand Rx | $30 copay | $75 copay | $25 copay (after deductible) | $50 copay (after deductible) | |||
| Non-Preferred Brand Rx | $60 copay | $150 copay | $40 copay (after deductible) | $80 copay (after deductible) | |||
| Specialty Rx | $100 copay | $100 copay | $100 copay (after deductible) | $100 copay (after deductible) | |||
| Quantity | 30 day supply | 90 day supply | 30 day supply | 90 day supply | |||
| Maximum Rx out of pocket | $4,600 per individual / $9,200 per family (separate of medical OOP) |
$4,600 per individual / $9,200 per family (separate of medical OOP) |
$4,000 per individual / $8,000 per family (integrated with medical OOP) |
$4,000 per individual / $8,000 per family (integrated with medical OOP) | |||
| Refill limit for maintenance Rx | After one initial fill plus two refills for maintenance medications, the member will pay 100% of the cost for short term medications unless they move to a 90 day prescription at a CVS pharmacy or CVS CareMark mail service pharmacy. | ||||||
| Mandatory Generic Substitution | In addition to the coinsurance/copay, the member pays the difference between the brand drug and the generic drug price when there’s a generic alternative, regardless of whether the prescribing physician requests that the brand name be dispensed. | ||||||
