This chart is for medications you buy at pharmacies in your health plan’s network. Employees and retirees pay the same deductible and copayments.
| |
Tier 1 |
Tier 2 |
Tier 3 |
| Deductible |
Each participant must pay a $50 annual deductible before copayments apply (for the plan year, September 1 to August 31).
|
|
Non-maintenance drug bought at a participating retail pharmacy
|
$10
up to a 30-day supply
|
$25
up to a 30-day supply
|
$40
up to a 30-day supply
|
|
Non-maintenance drug bought through a mail order pharmacy
|
$30
up to a 90-day supply
|
$75
up to a 90-day supply
|
$120
up to a 90-day supply
|
|
Maintenance drug bought at a participating retail pharmacy
|
$15
up to a 30-day supply
|
$35
up to a 30-day supply
|
$55
up to a 30-day supply
|
|
Maintenance drug bought through a mail order pharmacy
|
$30
up to a 90-day supply
|
$75
up to a 90-day supply
|
$120
up to a 90-day supply
|
Participating pharmacies:
Copayments for up to a 30-day supply of non-maintenance, short-term medications are $10 for Tier 1 drugs, $25 for Tier 2 drugs, and $40 for Tier 3 drugs. For up to a 30-day supply of maintenance, long-term medication, you will be charged a retail maintenance copayment of $15 for Tier 1 drugs, $35 for Tier 2 drugs, and $55 for Tier 3 drugs. For HealthSelect participants, view a list of participating pharmacies on the Caremark website.
Non-participating pharmacies:
For up to a 30-day supply, you will be reimbursed 60 percent of the lesser of the amount you pay for the prescription, minus your copayment OR the average wholesale price of the drug, plus a dispensing fee, minus your copayment. Deductible will be subtracted if not met. HMOs are not covered.
Mail Order:
If you order prescription drugs through the mail order program offered by your health plan, you pay the following copayments for up to a 90-day supply: $30 for Tier 1 drugs, $75 for Tier 2 drugs, and $120 for Tier 3 drugs. Learn more about prescription drug mail order.
Generic Alternatives:
If you purchase a brand-name drug when a generic alternative is available (regardless of the reason), you will pay your generic copayment plus the cost difference between the brand-name and the generic drug.
By law, generic drugs must be as safe and effective as brand-name medications. Generic drugs are safe, effective, and cost less than brand-name drugs. Generic drugs are usually designated as Tier 1 – the lowest copayment - so ask your doctor to prescribe a generic (if available) or prescribe the least expensive medication available.
