PRESCRIPTION DRUG BENEFITS: INDIVIDUALS UNDER AGE 65 AND NOT MEDICARE ELIGIBLE
UNITEDHEALTHCARE CHOICE AND CHOICE PLUS OPTIONS( MEMBER CHOICE: ADMINISTERED BY EXPRESS SCRIPTS)
Retail Pharmacy Copay( up to a 30-day supply)
Maintenance Medication Copay( mail service or CVS pharmacy, up to a 90-day supply)
Mail Order( up to a 90-day supply)
Generic $ 10 copay * $ 20 copay * $ 20 copay *
Preferred Brand $ 30 copay $ 60 copay $ 60 copay
Non-Preferred Brand
Fill Limit for Maintenance( long-term) Medications
$ 50 copay $ 100 copay $ 100 copay
Maintenance medications( 30-day supply) filled at any network retail pharmacy. Lifetime fill limit: 2
Maintenance medications( 90- day supply) may be filled through the mail service or an in-network( CVS or Walgreens) pharmacy. No lifetime fill limits.
No lifetime fill limit
* Have a prescription for a drug you have never taken filled with a generic drug, and the first two fills are free!
If you have a prescription filled with a preferred or non-preferred brand name drug when a generic is available, and your doctor writes the prescription to be dispensed as written( DAW), you will pay the appropriate brand name drug copay.
FILLING YOUR PRESCRIPTIONS
If you are enrolled in UnitedHealthcare Choice or Choice Plus, your prescription drug benefits are administered by Express Scripts.
You can use mail order or your customized CVS or Walgreens Member Choice Pharmacy Network for maintenance medications.
One-time prescriptions or the first two fills of a maintenance medication can also be filled at retail pharmacies.
Kaiser Permanente plan members receive their prescriptions through Kaiser.
SAVEONSP
SaveOnSP is a service that will reach out and help manage questions, treatment plans and costs when certain drugs are prescribed for UHC Choice and Choice Plus members. If you are prescribed a medication covered by this program, Express Scripts will work with SaveOnSP to invite you into the program, and your financial responsibility for the medication will be reduced to zero.
However, if you have a prescription filled with a preferred or non-preferred brand name drug when a generic drug is available, and you request the brand name drug, you will pay the appropriate copay plus the difference in cost between the brand name drug and the generic drug.
KAISER PERMANENTE HMO
Filled at Kaiser Facility
Filled at Participating Retail Pharmacy
Mail Order( up to a 90- day supply)
Generic $ 10 copay $ 20 copay $ 20 copay
Preferred Brand $ 20 copay $ 40 copay $ 40 copay
Non-Preferred Brand
$ 40 copay $ 55 copay $ 55 copay
6 | METROPOLITAN WASHINGTON AIRPORTS AUTHORITY