Prescription drug coverage

Whether you take prescription drugs daily to manage a condition (maintenance drug) or need them to treat a temporary illness, each plan includes convenient prescription (Rx) drug coverage with features that help you make informed, cost-effective decisions.

Your pharmacy network

The Broad Network allows you to fill your prescriptions when you want, where you want. You will have access to over 65,000 pharmacies nationwide, including CVS/pharmacy®, Wal-Mart, and Rite Aid, as well as independent pharmacies.

90DayMyWay®–Meds in the mail or around the corner

Your plan covers two 30-day fills of maintenance drugs1 at pharmacies in the broad network. After that, you can get 90-day supplies of maintenance drugs for chronic conditions or long-term therapy only if filled from home delivery or at a participating, in-network retail pharmacy.

Save with generics

Your plan features a benefit that encourages the use of generic drugs to help you save money. If a generic drug is available and you request a brand-name drug, you will be charged the brand name-cost share plus the difference between the generic and brand-name drug. If your doctor writes that a brand name is required, you are only responsible for the applicable brand-name cost share.

Medication synchronization

If you take two or more maintenance medications, you may obtain a partial supply of each medication up to three times a year for medication synchronization purposes at an in-network retail pharmacy.

Formulary

Visit the Formulary for more information on drugs covered by your health plan.

Value formulary (all plans except QHDHP plans)

Most of our plans utilize the Value formulary which offers many preventive medications at no cost to you.

New drug benefits:

  • New generic maintenance drugs at no cost to you for certain chronic conditions such as such as high cholesterol, high blood pressure, diabetes, osteoporosis, transplants, depression and gastrointestinal conditions.
  • Insulin Saver Program which covers certain preferred insulins at a $5 copay for a 30 day supply at retail pharmacies and a $15 copay for a 90 day supply through home delivery.

Advantage formulary (QHDHP plans only)

If you choose a QHDHP plan you will also have access to certain preventive drugs at no cost to you with the Advantage formulary. Additionally, there are many other preventive and maintenance drugs available where the deductible will be waived and you will only be charged a copay.


1 A maintenance medication is taken regularly for chronic conditions, like high blood pressure, asthma, diabetes, or high cholesterol.