Overview

All of the medical plans available to you include coverage for prescription drugs. OptumRx is our prescription drug administrator for Anthem, UHC and the Scott & White Health Plan. Specialty drugs are administered by BriovaRx. If you enroll in a Kaiser medical plan, Kaiser will administer your prescription drug benefits. You must pick up your prescriptions at a Kaiser facility or via the Kaiser Mail Order program.

The chart below shows what you will pay for prescription drugs.

Type of prescription drug $900 Deductible Plan* $1,500 Deductible Plan* $2,850 Deductible Plan $4,500 Deductible Plan $6,550 Deductible Plan
Retail
Generic 30%
(max you pay is $20)
20% 30%, after deductible 30%, after deductible $0, after deductible
Preferred brand 30%
(max you pay is $50)
20% 30%, after deductible 30%, after deductible $0, after deductible
Non-preferred brand 45%
(max you pay is $80)
20% 30%, after deductible 30%, after deductible $0, after deductible
Mail-order
Generic 30%
(max you pay is $50)
20% 30%, after deductible 30%, after deductible $0, after deductible
Preferred brand 30%
(max you pay is $125)
20% 30%, after deductible 30%, after deductible $0, after deductible
Non-preferred brand 45%
(max you pay is $200)
20% 30%, after deductible 30%, after deductible $0, after deductible

* In the $900 Deductible and $1,500 Deductible Plans, prescription drug costs do not count toward the medical plan deductible. You also do not need to meet the deductible for prescription drug coverage in the $900 and $1,500 deductible plans.

In the Anthem, UnitedHealthcare and Scott & White HSA-eligible plans, Rollins covers many preventive medications and Lifescan One Touch diabetic test strips at 100% — without having to meet the medical plan deductible. You can review the Optum HDHP Preventive Drug $0 Copay List to see what’s included. Kaiser will cover certain preventive and maintenance drugs without having to meet the deductible, but coinsurance may apply. Many drugs will be covered at low or no cost.

Key things to know about your prescription drug coverage

  • All medical plan participants will receive medical and prescription ID cards.
  • There is no separate prescription drug deductible. However, the medical deductible applies in the high-deductible plans. You pay coinsurance for all prescription drugs filled at an in-network pharmacy — retail and mail order.
  • Preventive maintenance medications are covered at 100%.
  • All formulary lists can be found on the Forms and Plan Summaries page.
  • You receive program discounts when you use OptumRx network pharmacies.
  • Prescriptions filled at non-network pharmacies are not covered under any plan.
  • Some prescription drugs require Prior Authorization by your doctor. Oncology prescriptions are part of this program.
  • If you or your provider requests a preferred or non-preferred brand drug when a generic alternative is available, you will be responsible for the difference in cost between the brand and generic drug.
SAVE MONEY ON YOUR PRESCRIPTIONS

Use OptumRx's Price and SaveTM Tool to compare the cost of medications at local and home delivery pharmacies to save on your prescriptions. Click here and log into your OptumRx account to get started. If you enroll in the Kaiser plans, you can find a pharmacy, see what drugs are covered and refill mail order prescriptions all online through Kaiser’s website.

Find Your Prescriptions for Less

USE NETWORK PROVIDERS

Before you fill a prescription, check to see if your pharmacy is in the network.

Take advantage of mail order

Mail order pharmacies are a convenient and cost-effective way to order long-term medications such as medication for high blood pressure or diabetes. You can get up to a 90-day supply delivered to your home.

The Mail Order program is not mandatory. If you take a maintenance drug — like high blood pressure medications or birth control — you can choose whether to use a retail pharmacy or use the Mail Order program.

SUMMARIES OF BENEFITS AND COVERAGE

You have access to a Summary of Benefits and Coverage (SBC) and Plan Summaries for each of your medical plan options. These documents provide detailed information about coverage and costs to help you compare plans and make informed decisions. To access the SBCs and SPDs, see Forms and Plan Summaries.

WHAT WILL YOU PAY?

Your specific premiums per pay period will be displayed as you’re enrolling on the enrollment site. Or, you can click to see what you’ll pay now.