Pharmacy Benefits
Whether your prescriptions are filled at your local pharmacy or dispensed directly from your doctor or hospital's outpatient department, your Basic Option pharmacy benefits will have you covered.
Basic Option features four levels of benefits. In most situations, you will pay the lowest copayment for any generic medicine and a mid-level copayment for cost-effective, Preferred brand name medicines. The highest copayment level applies to situations where you may be prescribed Non-formulary, Non-preferred brand name medicines.
2013 Basic Option — Prescription Drug Coverage
Here's how your prescription drug benefits work for up to a 34-day supply of medicine. A 90-day supply is available for three copayments.
| Benefit Description | You Pay |
|---|---|
Retail Benefit | Tier 1 (Generic): $10 copayment for generic drugs. Tier 2 (Preferred Brand): $40 copayment for Preferred brand-name drugs. Tier 3 (Non-preferred Brand): 50% with $50 minimum for non-Preferred brand-name drugs. Tier 4 (Specialty): For specialty drugs purchased at a Preferred retail pharmacy, you pay a $50 copayment for a 34-day supply or $150 for a 90-day supply. |
Specialty Drug Pharmacy Program | Tier 4 (Specialty): You pay a $40 copayment for a 34-day supply or $120 for a 90-day supply. |
Immunizations
| Benefit Description | You Pay |
|---|---|
Influenza Vaccine Benefit
| No cost to you Note: You pay nothing for Influenza (flu) vaccines obtained at Non-preferred retail pharmacies |
Routine immunizations [as licensed by the U.S. Food and Drug Administration (FDA)], limited to:
| No cost to you when provided by a Preferred retail pharmacy that participates in our vaccine network and administered in compliance with applicable state law and pharmacy certification requirements |
To learn more about how to fill your prescriptions and make the most of your prescription benefits, visit the Pharmacy section of this Web site. Information about your prescription benefits is also available in your Service Benefit Brochure (RI 71-005).
Page last updated: December 31, 2012