BACK

Prescription Drug Summary: Building Trades & Flexible Choice Plans

Program Generic Drugs Preferred Brand Name Drugs Non-Preferred Brand Name Drugs
Retail Program

Up to a 34-day supply or 100 units, whichever is greater

You pay 10% with a $10 minimum*/$100 maximum copay per initial fill and refill You pay 20% with a $15 minimum*/$100 maximum copay per initial fill and refill You pay 30% with a $30 minimum*/$100 maximum copay per initial fill and refill
Mail Order Program

Up to a 90-day supply

You pay a $15 copay per initial fill and refill You pay 20% with a $40 minimum*/$200 maximum copay per initial fill and refill You pay 30% with a $60 minimum*/$200 maximum copay per initial fill and refill
Voluntary Self-Injectable Specialty Drug Program You pay 10% with a $10 minimum*/$100 maximum copay per initial fill and refill You pay 20% with a $15 minimum*/$100 maximum copay per initial fill and refill You pay 30% with a $30 minimum*/$100 maximum copay per initial fill and refill
In-Network Out-of-Pocket Maximum Building Trades Plan:
Individual $1,650
Family $8,800Flexible Choice Plan:
Individual $1,600
Family $8,200
Sav-Rx Network Usage Requirement Benefits are not payable for prescriptions filled at pharmacies that are not in the Sav-Rx network. Check to make sure that your pharmacy is part of the Sav-Rx network before filling your prescription. Note: Not all chains/pharmacies are in the Sav-Rx network, including Wal Mart, Sam’s Club, and certain Rite-Aid locations.
Generic Medication If your doctor indicates a generic medication is acceptable, but you choose to have your prescription filled with a preferred or non-preferred brand name drug, you must pay the difference in cost between the preferred or non-preferred brand name and the generic medication, plus the preferred or non-preferred brand name copayment amount.

*Note: If the cost of a medication is less than the minimum copay amount, you are responsible for the actual cost of the medication, plus the dispensing fee. For example, if a preferred brand name medication costs $7 (the Plan’s minimum copay is $15 retail/$40 mail order), you will pay $7, plus the dispensing fee—not the applicable minimum copay.

Note: Specialty drugs are generally high-cost drugs used to treat serious and/or chronic conditions. If your drug is part of the High Impact Advocacy Program you must fill your specialty medications through the Sav-Rx Specialty Pharmacy. If your specialty drug is not part of the High Impact Advocacy Program, you may fill your specialty medication through a participating pharmacy, the Mail Order Pharmacy or the Specialty Pharmacy.