The Prescription Benefit is not subject to the medical deductible. The in-network out-of-pocket limit for the prescription plan is $2,000 for an individual.

Below is a summary of the prescription benefit. For further information on specific drug coverage participants must contact Sav-Rx or reference the health plan document.

Sav-Rx

Sav-Rx has a network of over 72,000 pharmacies nationwide. You can choose to pick up your medications at a local pharmacy or receive your medications via the Sav-Rx mail order pharmacy. New in 2019 – Sav-Rx allows pick up of generic medications at participating retail locations. Pharmacy plan benefits apply to medications received through Sav-Rx mail orders or retail pharmacy pick ups. Contact Sav-Rx at 1-800-228-3108 or at www.savrx.com.

30-day supply:


• $10 Copayment for generic prescriptions

• 40% up to a maximum $80 for preferred brand name prescriptions

• 50% up to a maximum $180 for non-preferred brand name prescriptions

90-day supply through mail order:


• Generic prescriptions have a $20 Copayment

• Preferred Brand name prescriptions (Formulary) have a $165 Copayment

• Non-Preferred brand name prescriptions (Non-Formulary) have a $265 Copayment

• Brand with Generic have a $265 copayment plus difference in cost.

90-day supply through any retail pharmacy participating with Sav-Rx:

• Generic prescriptions have a $30 Copayment
• Preferred Brand name prescriptions have a 40% coinsurance up to a maximum $240.

• Non-Preferred brand name prescriptions have a 50% coinsurance up to a maximum $540

Some medications require prior authorization. If prior authorization is required and not received the medication may cost more or the Plan may not cover it. Other medications may have a quantity limit or require step therapy.