Prescription Drug Benefits

NATIONAL MEDICAL PLAN OPTIONS (CIGNA AND UNITEDHEALTHCARE)

Starting January 1, 2017, employees are encouraged to enroll in mail order delivery for new or existing prescriptions for maintenance medications. Until you enroll, you will have three grace fills, per medication, at a retail pharmacy. If you have not enrolled in mail order at the fourth fill at a retail pharmacy, you will pay 100% of the cost of the medication. Maintenance medications are those you take on an ongoing basis for conditions such as diabetes, high blood pressure and high cholesterol, as well as birth control and certain behavioral health medications.

Enrolling in mail order is easy and saves you time and money.

How it Works

  1. Your doctor prescribes you a maintenance medication. If you are already taking an eligible maintenance medication, skip to step 2.
  2. Cigna Pharmacy or OptumRx notifies you that mail order is available to you.
  3. You have three grace fills (30-day) at a retail pharmacy before you must enroll in the mail order program. If your doctor decides to change your dose or brand, you will have another three fill opportunities before enrolling in the mail order program.
  4. If you are not enrolled in the mail order program by the fourth retail fill, you will have to pay 100% of the cost of the medication. This cost will not apply to your deductible or out-of-pocket maximum.

Enroll online at mycigna.com or optumrx.com or call a representative. Cigna Pharmacy or OptumRx representatives will contact your doctor directly to obtain the necessary prescription and contact you if your doctor does not provide the prescription.

Cigna 90-Day Retail Option

Members enrolled with Cigna have the option to choose to pick up a 90-day prescription at participating pharmacies, in addition to the home delivery option. Learn More

Prescription Drug Copay and Coinsurance Maximums

The minimum and maximum copay and coinsurance amounts for prescription drugs will increase effective January 1, 2017 to keep up with the rising cost of prescription drugs. Learn More

KAISER CALIFORNIA

Participants in California with Medical Plan coverage administered by Kaiser should be aware of the following changes for 2017:

  • Northern California: Your coinsurance for specialty prescription drugs is increasing to 30%, up to $150 for up to a 30 day supply. Learn More
  • Southern California: Your coinsurance for specialty prescription drugs is increasing to 20%, up to $150 for up to a 30 day supply. Learn More
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