PPO Savings Plan: Prescription Coverage - Teamsters

2017 PPO Savings Prescription Coverage Chart for Teamsters
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

Maintenance Drugs Mail Order (90-day supply)*
Plan pays 90% after deductible
Specialty Medications
Walgreens Specialty Pharmacy Only
Specialty Medication Formulary

Retail Drugs (31-day supply)
Plan pays 90% after deductible