Prescription drugs

What you need to know

Your prescription drug benefits depend on the medical plan you choose. Each HMO plan manages its own prescription drug benefits, while CVS/caremark provides prescription drug benefits for participants in the UnitedHealthcare (UHC) plans.

Save money with these tips

Whenever possible, ask for a generic equivalent to save money, and use in-network pharmacies to avoid paying more. 

UHC, Kaiser Permanente (CA), and Health Net (AZ) medical plan members receive in-network maintenance drugs at no cost to help manage ongoing or chronic medical conditions, such as:

  • Diabetes
  • High blood pressure
  • High cholesterol

All of our medical plans cover certain preventive anti-cancer medications at no extra cost for women over age 35 with increased risk of breast cancer and annual screenings for certain individuals at risk for lung cancer, including CT scans of the thorax.

What you pay under the UHC medical plans

You can get a 30-day supply of medication from retail pharmacies.

If you're on a maintenance medication, such as high blood pressure medication, for an extended period of time, consider the mail-order option, which provides a larger quantity for a reduced copay. 

UHC participants can pick up to a 90-day supply of maintenance prescriptions at their local CVS or Target pharmacy, in addition to using the mail-order drug program. 

  UHC $300 Deductible UHC CDHP with HSA*
Generic In-network: $10
Out-of-network: $10 + 50%
In-network: 10% after deductible
Out-of-network: 30% after deductible
Brand formulary In-network: $25
Out-of-network: $25 + 50%
In-network: 10% after deductible
Out-of-network: 30% after deductible
Brand non-formulary In-network: $40
Out-of-network: $40 + 50%
In-network: 10% after deductible
Out-of-network: 30% after deductible
Maintenance medications Mail order or at CVS or Target pharmacies: Up to a 90-day supply for just 2 times the retail copay amount. Check with the plan for details about mail order. Mail order or at CVS or Target pharmacies: Up to a 90-day supply for just 2 times the retail copay amount. Check with the plan for details about mail order.

*Under the UHC CDHP with HSA , deductibles and coinsurance apply. You are responsible for full prescription costs until you reach combined deductible.

Prescription Drug Out-of-Pocket Maximum

After you reach your out-of-pocket maximum, the plan pays 100% of eligible expenses for the remainder of the plan year. Under both UHC plans, prescription out-of-pocket maximums are included in the medical out-of-pocket maximum.

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What you pay under the HMO medical plans

You can get a 30-day supply of medication from retail pharmacies.
If you're on a maintenance medication, such as high blood pressure medication, for an extended period of time, consider the mail-order option, which provides a larger quantity for a reduced copay. 

  Kaiser HMO (CA) Health Net HMO (AZ) SelectHealth HMO (UT)
Generic $10 $10 $10
Brand formulary $25 $25 $25
Brand non-formulary $25 $40 $45
Maintenance medications Mail order: Up to a 90-day supply for just 2 times the retail copay amount. Check with the plan for details about mail order Mail order: Up to a 90-day supply for just 2 times the retail copay amount. Check with the plan for details about mail order N/A

Prescription Drug Out-of-Pocket Maximum

After you reach your out-of-pocket maximum, the plan pays 100% of eligible expenses for the remainder of the plan year:

Kaiser HMO and SelectHealth HMO: Prescription out-of-pocket maximums are included in the medical out-of-pocket maximum.

Health Net HMO: There is a separate, additional out-of-pocket maximum for prescription drug expenses of $1,000 per individual and $2,00 per family.

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