Prescription Drug Benefits

No matter which medical plan you choose, prescription drug coverage is included for you and your family. You can purchase your prescription medications at a pharmacy or through a mail order program. Generally, you can fill a prescription for up to a one-month supply at a retail pharmacy. If you use mail order, your prescription can be filled for up to 90 days.

Maintenance Medications

If you are on medication that you must take on a regular and continuing basis, like blood pressure or cholesterol medication, you will pay less by getting your prescription filled by mail order because one co-payment can purchase a 90-day supply.

If you are in the PPO or BlueChoice HMO, your prescription drug ID card is a separate card provided by UnitedHealthcare®/OptumRx®. When you visit a network pharmacy, you will need to present your ID card and pay a co-payment for each prescription. Many pharmacies participate in the UnitedHealthcare/OptumRx network. If you fill a prescription at a non-participating pharmacy, you will generally pay full price for the prescription. You must then file a claim with your prescription drug program to be reimbursed for the in-network price.

If you are in the Kaiser HMO, your prescription drug ID card is the same as your medical ID card. When you visit a network pharmacy, you will need to present your ID card and pay a co-payment for each prescription. Many pharmacies participate in the Kaiser Permanente network. If you fill a prescription at a non-participating pharmacy, you are responsible for the entire amount charged by the pharmacy.

Your Prescription Drug Benefits
If Your Medical Plan Is:Your Prescription Drug Program Is: Your Co-Payment Is:
Retail Network (30-day supply)Non-Network(30-day supply)Mail Order (90-day supply)
Kaiser Permanente HMO Kaiser Permanente Generic $5 $10 $10
Formulary brand $20 $40 $40
BlueChoice HMO UnitedHealthcare/OptumRx Generic $5 Full cost of drug $10
Formulary brand $20 Full cost of drug $40
Non-Formulary $30 Full cost of drug $60
CareFirst PPO UnitedHealthcare/OptumRx Generic $5 Full cost of drug $10
Formulary brand $20 Full cost of drug $40
Non-Formulary $30 Full cost of drug $60

Covered prescription drugs must be medically necessary as determined under the rules of the carrier. In addition, certain prescription drugs may be subject to exclusions, limitations or prior authorization for medical necessity. Refer to the benefit booklet from your carrier or contact your carrier for more details.

The Plan participates in the UnitedHealthcare/OptumRx fraud, waste and abuse program, which monitors patient and prescriber patterns to identify outliers and situations of abnormal utilization or prescribing. UnitedHealthcare/OptumRxand the Plan collaborate in identified cases of fraud, waste and abuse. The Plan can determine whether to restrict member access to pharmacies and physicians.

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FAQs

We just had a child. Can I add my child to my coverage?

Yes, your newborn child will be covered by the Plan from the date of birth, as long as you enroll the child within 30 days from the date of birth. If you enroll the child between 31 and 90 days after the date of birth, coverage for the newborn child begins on the first of the following month. If you miss this 90-day period, you will not be able to enroll your newborn child until the next Open Enrollment Period. You will need to provide the Plan with the necessary documentation. For more information, visit the "If You Have a Baby" section on the Life Events page.

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