When you elect medical coverage, you are automatically covered under a prescription drug plan. Prescription drug coverage is provided through Medco. If you are currently not enrolled, but considering enrolling in a UH medical plan and would like to review general information about the prescription drug plan, select the appropriate link below:
- For Traditional Medical Plan general prescription information, click here
- For Consumer Select Plan general prescription information, click here
How to Fill Your Prescriptions
- Participating retail pharmacies
- Through a mail order program if you take maintenance medications
- Specialty medications are available through UH Home Care’s Specialty Pharmacy at 1-800-552-8442
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If you are not enrolled in a UH medical plan for 2011 and choose UH medical coverage for 2012, you will receive a prescription drug ID card from Medco to use in 2012. |
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When you have a prescription filled, the amount you pay is based on what type of drug you choose – generic, formulary brand name or non-formulary brand name.
Here is an overview. Keep in mind that when you reach the out-of-pocket maximum, the plan will pay 100% of your costs for the rest of the plan year. Note: If you enroll in the Consumer Select Plan, you will need to meet the plan deductible before the plan pays for prescriptions.
| Drug Type |
Retail Pharmacy
(30-day supply) |
Mail Order
(90-day supply) |
| Generic |
$10
|
$25
(with over 400 drugs available for $10) |
| Formulary brand name |
30%, $30 minimum,
$100 maximum |
20%, $75 minimum,
$250 maximum |
| Non-formulary |
50%, $70 minimum,
$200 maximum |
50%, $175 minimum,
$500 maximum |
* If the full cost of the drug is less than the minimum, you pay the full cost of the drug.
Important Information about Purchasing Your Maintenance Drugs
Mail order is the preferred way to fill your maintenance medications. Here is what this means:
- You can fill your maintenance medication two times at a participating retail pharmacy. (“Maintenance” means you take a drug regularly, like high blood pressure medication.)
- The third time you fill your prescription, you pay the full discounted cost, unless you enroll for mail order.
Go to www.medco.com to sign up for mail order. If you do not wish to use mail order, you will be responsible for paying the full discounted cost of the prescription drug and your expenses for those maintenance drugs will not apply to the out-of-pocket maximum.
In rare circumstances, you may be able to purchase a medication at a retail pharmacy for a lower cost than using Medco mail order. In this event, you can request a mail order exception through an appeal process by submitting a letter requesting an appeal, along with the pharmacy receipt showing the total price of the drug, the quantity and drug strength. Be sure to include your name, ID number and contact information.
Fax the request to 1-888-235-8551, or mail it to Medco Admin Appeals at Medco Health Solutions, P. O. Box 631850, Irving, TX 75063-0030. After Medco reviews your information, you will receive written approval or denial of the appeal request.
Generic vs. Brand Name Drugs
You pay the lowest amount by choosing a generic drug (if available). Plus, when you choose among 400 drugs from Medco’s list, you pay even less – $10 for a 90-day supply of generic mail order medications.
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| A generic drug is one that meets the standards for brand name drugs for safety, purity, strength, and effectiveness. Generic drugs contain identical active ingredients at the same doses as the brand name drug and are usually sold under the chemical name for the drug. You pay a lower coinsurance amount when you elect generic drugs. |
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A brand name drug is a drug that is protected by a patent issued to the original innovator or marketer. The patent prohibits the marketing of the drug by another company as long as the patent remains in effect. |
Is Your Medication Covered? The prescription drug plan provides coverage for prescription drugs that are listed on Medco’s Formulary Drug List. Certain prescription drugs may require prior authorization, step therapy or require specific quantity limits.
The plan covers drugs for smoking cessation and infertility, oral contraceptives and diabetic supplies. Here is an overview.
| Prescription smoking cessation drugs are covered at at 100% under the plan. |
| Prescription drug coverage is provided for the treatment of infertility. The prescription drug coinsurance for infertility drugs is 50%. This coinsurance does not count toward the annual maximum out-of-pocket limit. The lifetime maximum benefit is $5,000. |
| Oral contraceptives and contraceptive devices that are listed on the Medco formulary drug list are covered. Contraceptive implants and devices are covered under the medical benefit. |
| Meter strips, lancets, syringes, and needles for insulin injections, along with one glucose meter per year will be covered at one coinsurance per prescription. A maximum of 200 meter strips per person per month will be covered. |
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