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Prescription Drug Plan

The Select and Choice PPO plans offer two ways to save money on prescription drugs - through retail pharmacies and the mail order service. Both are administered by PharmaCare Management Service, Inc. .

Retail Pharmacy Benefits

You can get your prescription filled at any pharmacy participating in the PharmaCare pharmacy network. The PharmaCare network includes many independent pharmacies and most major pharmacy chains. The plan pays covered prescriptions at 100% after you pay the applicable co-payment. Your co-payment will depend on the type of prescription drug you receive - generic, preferred brand name or non-preferred brand name prescription drugs. What are generic, preferred and non-preferred brand name drugs? Click here for a description.

Prescription Drugs

Plan 1-Select Plan

Plan 2 Choice
Plan PPO

(Managed Healthcare Northwest Providers)

Plan 2-Choice
Plan PPO

(Any Provider)

Managed Pharmacy

Administered by PharmaCare

Administered by PharmaCare

Administered by PharmaCare

Retail 30-Day Supply

Prescription drug purchases at a participating pharmacy.

Generic: 100 % after $12 copayment

Preferred Brand: 20% coinsurance ($20 miniumum; $70 maximum)

Non-Preferred Brand: 35% coinsurance ($40 minimum; $90 maximum)

Prescription drug purchases at a participating pharmacy.

Generic: 100 % after $12 copayment

Preferred Brand: 20% coinsurance ($20 miniumum; $70 maximum)

Non-Preferred Brand: 35% coinsurance ($40 minimum; $90 maximum)

If you use a non-participating pharmacy, you will pay 100% of the prescription cost at the time of purchase. You must then file a paper claim form along with the original prescription receipt to PharmaCare for covered medications. The out-of-network pharmacy cost will be paid at the same amounts as an in-network pharmacy. The plan participant pays the difference.

Prescription Drug Annual Out-of-Pocket Maximum (Applies to Retail and Mail Order Drugs)

$2,000 per individual (combined In-Network and Out-of-Network)

$2,000 per individual (combined In-Network and Out-of-Network)

$2,000 per individual (combined In-Network and Out-of-Network)


Mail Order Pharmacy Service

Maintenance medications taken on a regular basis for conditions such as high blood pressure or diabetes can also be filled through the PharmaCare mail order service and mailed directly to your home. You can place your order by completing a Mail Service Enrollment Form, registering online at www.pharmacare.com, or by calling the mail order customer service at (888) 645-9303.

Prescription Drugs

Plan 1-Select Plan

Plan 2 Choice
Plan PPO

(Managed Healthcare Northwest Providers)

Plan 2-Choice
Plan PPO

(Any Provider)

Mail Order 90-Day Supply *

Prescription drug purchases ordered through mail order vendor.

Generic: $30 Preferred Brand: $60 Non-Preferred Brand: $100

Prescription drug purchases ordered through mail order vendor.

Generic: $30 Preferred Brand: $60 Non-Preferred Brand: $100

Not covered. Must use mail order vendor (see in-network)

Prescription Drug Annual Out-of-Pocket Maximum
(Applies to Retail and Mail Order Drugs)

$2,000 per individual

$2,000 per individual

$2,000 per individual

* By law, PharmaCare must fill your prescription for the exact quantity of medication prescribed by your health care provider, up to the 90-day plan limit. “30 days plus 2 refills” does not equal one prescription written for “90 days.” Be sure your health care provider writes the prescription accurately.

Definition of Drugs - What are generic, preferred, and non-preferred drugs?

Generic Drugs

Generic drugs have brand name equivalents but are significantly less expensive than the brand name.To be sure you pay the lowest co-payment, ask your doctor to prescribe generic medications, when appropriate.

Preferred Drugs

Preferred Prescription Drugs are brand name drugs that are effective for treating specific condition and are more cost-effective than equivalent non-preferred drugs. Often there is a choice of medications you can take for the same condition. One or more of these medications may be a preferred drug under this plan.

Non-Preferred Drugs

Non-Preferred Drugs are brand name drugs that are less cost-effective than preferred brand name drugs, but not more therapeutically effective than preferred brand name or generic drugs. Non-preferred drugs require a higher co-payment. Depending on your personal health care needs, there may be times when non-preferred drugs are right for you. In these situations, you will need to pay the non-preferred co-payment.

Mandatory Generic Requirement: All prescriptions filled under the retail or mail order prescription drug program will be automatically filled with the generic version of medication (if one is available). Otherwise, you will be charged the difference in the price between the brand-name and generic version of that medication, pus the generic copay.

THE LISTING OF PREFERRED BRAND DRUGS CAN BE OBTAINED FROM THE HUMAN RESOURCE DEPARTMENT OR YOU MAY REQUEST THE LIST FROM PHARMACARE.

Important note: You will pay the non-preferred drug co-payment if a generic or preferred brand name drug is not available.