Pharmacy Benefits
Both Health Plan Levels: Ultimate and Best have the same Prescription Benefits with identical cost sharing. As of 01/01/2022, there are no more preferred network pharmacies.
Your benefits include:
- 90 Day Supply
- $5 co-pay per month for generics (one month is $5, three months is $15)
- Minimum of $15 co-pay for preferred brand medications or 25% of the approved cost
- Minimum of $40 co-pay for non-preferred brand medications or 45% of the approved cost
- The maximum out of pocket expense per 30-day prescription is $100 and $300 per 90-day prescription.
*Maximum out of Pocket Expenses can be adjusted annually by Board of County Commissioners, refer to the benefits section for current values.
Specialty Pharmacy Benefit
Minimum of 25% up to $150 Prescription Maximum Out-of Pocket Expenses. This applies to brand and generic specialty medications.
Mail Order Benefit
You can use mail order services offered through OptumRx to fill your prescriptions. Go to the Optum Rx Website or call 800-562-6223 for details.
Your mail order benefits include:
- Up to 90 Day Supply
- Minimum of $5 co-pay for generics or 15% of the approved cost
- Minimum of $15 co-pay for preferred brand medications or 25% of the approved cost
- Minimum of $100 co-pay for non-preferred brand medications or 50% of the approved cost
- The maximum out of pocket expense per 30-day prescription is $100 and $300 per 90-day prescription.
