The pharmacy benefit includes several options that drive value and affordability for members who are taking medications used to treat certain chronic conditions.
Benefit Features
No-Cost Generic Medications
No-Cost Generic Medications is automatically included in the pharmacy benefit if you have 50 or less employees. It includes certain generic medications that are covered at no cost when filled at a retail pharmacy or through the mail service pharmacy, and are used to treat the following chronic conditions:
- diabetes
- depression
- heart disease
- high blood pressure
- high cholesterol
Lower-Cost, Brand-Name Insulins
You can opt-in to this benefit if you have 51 or more employees. The cost share can be customized to a lesser amount if you have 100 or more employees. The plan deductible is waived on Health Savings Accounts (HSA)-qualified “Saver” plans.
This benefit provides a fixed cost for brand-name insulin medications of $25 at a retail pharmacy and $50 through the mail service pharmacy. Some of these insulins are also eligible for the value-based benefit, which can reduce a member’s out-of-pocket costs even more when they are filled through the mail service pharmacy.
$0 Copay Medications
You can opt-in to this benefit if you have 100 or more employees. This benefit provides a $0 copay for medications that are filled at a retail pharmacy or through the mail service pharmacy, and are used to treat the following conditions:
- certain heart conditions
- depression
- diabetes
- high blood pressure
- high cholesterol
- some respiratory ailments
- substance and opioid use disorder
The benefit also includes diabetes testing strips and smoking cessation medications. You can pick and choose which categories to include in this benefit.
This $0 Copay Medications benefit and the Value-Based Benefit cannot be included in your pharmacy coverage at the same time.
Pharmacy Network
Our National Network offers members access to over 65,000 pharmacies nationwide, including thousands of pharmacies and most major chains. Members can also find an in-network pharmacy using our Pharmacy Locator tool.