It is easy to fill prescriptions at any In-Network pharmacy (Target, Walmart, and many more). Just present your Health Plan ID card, and the pharmacist will tell you your share of the cost (if any).
When your health care provider prescribes a medication, you may want to check if there are effective medications that would cost you less under the Alliance Plan.
|COVERAGE TIER||YOUR SHARE OF THE TOTAL COST (IN-NETWORK) PER PRESCRIPTION FILL|
|Approved Over-the-Counter (Tier 1)||0% only when prescribed and dispensed at on-site Health Centers|
|Approved Preventive (Tier 1)||0% (certain drugs covered only when dispensed at on-site Health Centers)|
|Approved Disease Management (Tier 1)||$5 copay, then $0|
|Generic Preferred (Tier 1)||$5 copay, then $0 (some $0 copay exceptions noted in Formulary)|
|Generic Non-Preferred (Tier 2)||10% ($10 minimum coinsurance)|
|Brand-Name Preferred (Tier 3)||20% ($10 minimum coinsurance)|
|Brand-Name Non-Preferred (Tier 4)||40% ($10 minimum coinsurance)|
|Specialty Preferred (Tier 5)||10% ($100 minimum coinsurance; $300 maximum coinsurance)|
|Specialty Non-Preferred (Tier 6)||20% ($200 minimum coinsurance; $600 maximum coinsurance)|
Certain medications require prior authorization, step therapy, or substitution with clinical alternative, or you pay 100%. For certain medications, additional restrictions apply on brand names, non-approved products, or quantities. For more information, see the Prescription Drug section of the Benefits Handbook (SPD). If you use an Out-of-Network parmacy, the Plan will pay only the amount it would have paid to an In-Network pharmacy, and you will pay the balance.
Prescription Drug Coverage Tiers (Formulary)
EnvisionMail mail-order pharmacy:
The Summary Plan Description (SPD) has more details about this benefit, such as: