PPO Savings Plan: Prescription Coverage - Faculty & Staff

2017 PPO Savings Prescription Coverage Chart for Faculty & Staff
Deductible Integrated with medical deductible

Prescription Drug Program

Defined by the Premier 2012 pharmacy network - NOT Physician Network. Prescriptions filled at a non-network pharmacy are not covered

Plan uses the Comprehensive Formulary.

*Retail and Mail Service Pharmacy includes University Health Services Pharmacy

Retail Drugs (31-day supply)*
Plan pays 90% after deductible per generic
Plan pays 80% after deductible per formulary brand
Plan pays 60% after deductible per non-formulary brand

Maintenance Drugs Mail Order (90-day supply)*
Plan pays 90% after deductible per generic
Plan pays 80% after deductible per formulary brand
Plan pays 60% after deductible per non-formulary brand
Specialty Medications
Walgreens Specialty Pharmacy Only
Specialty Medication Formulary

Retail Drugs (31-day supply)
Plan pays 80% with a $65 minimum after deductible per generic
Plan pays 80% with a $65 minimum after deductible per formulary brand
Plan pays 60% with a $100 minimum after deductible for non-formulary brand