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Prescription Drugs

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Overview

All three medical care options provide the same basic prescription coverage once you meet your annual deductible.

Learn more about the OptumRx Mail Order Program

Plan Details

Your Prescription Drug Coverage


Retail*	Mail Order*
In-network: Up to a 30-day supply	In-network: Up to a 90-day supply***
Out-of-network: No coverage	Out-of-network: No coverage
Generic Drugs: $12 co-pay after annual deductible; 90-day supply** $24 co-pay after deductible	Generic Drugs: $24 co-pay after annual deductible
Brand Name Drugs: 30% co-insurance, after annual deductible; 90-day supply 20% co-insurance, after deductible	Brand Name Drugs: 20% co-insurance, after annual deductible
Specialty Drugs: 30-day supply $120 co-pay, no annual deductible for Options 1 & 2, Option 3 after annual deductible; 90-day supply $360 co-pay, no annual deductible for Options 1 & 2, Option 3 after deductible	Specialty Drugs: $360 co-pay, no annual deductible for Options 1 & 2, Option 3 after deductible
Targeted Drugs: $12 co-pay, no annual deductible for Options 1 & 2, Option 3 after annual deductible; 90-day supply $24 co-pay, no annual deductible for Options 1 & 2, Option 3 after annual deductible	Targeted Drugs: $24 co-pay, no deductible for Options 1 & 2, Option 3 after annual deductible

*Brand/generic difference applies
**Get a 90-day supply for eligible medications through OptumRx mail order.
***OptumRx can now accept some manufacturer coupons/copay cards at mail order. Contact OptumRx to see if your coupons/copay cards are eligible for mail order.

Statins: Select generic statin drugs to treat high cholesterol will be covered at 100% and are not subject to your annual deductible. Select statins are: Atorvastatin, Simvastatin, Pravastatin, Rosuvastatin, Lovastatin, Fluvastatin.
Select drugs used to treat opioid addiction are covered at 100% and are not subject to annual deductible for those enrolled in Options 1 & 2. Option 3 covered at 100% after annual deductible is met.
Select generic drugs to treat high blood pressure and 10-day supply of certain generic antibiotics will be covered at 100%. Not subject to annual deductible for those enrolled in Options 1 & 2. Option 3 is covered at 100% after annual deductible is met.
Low cost for certain asthma medications (Retail: $12 co-pay, no annual deductible for Options 1 & 2, Option 3 after annual deductible; 90-day supply $24 co-pay, no annual Deductible for Options 1 & 2, Option 3 after annual deductible/Mail Order: $24 co-pay, no deductible for Options 1 & 2, Option 3 after annual deductible)

Diabetic Supplies

Retail/mail in-network: 100%, no annual deductible
Out-of-network: No coverage

Glucose monitors - One per year
Insulin - Applicable prescription drug co-pays and co-insurance apply
Syringes/needles (lancets, test strips, alcohol swabs) and related insulin pump supplies (e.g. cartridges, reservoirs and tubing)
Insulin pumps (available through the medical plan or prescription drug plan)

Diabetic supplies (glucose monitors, syringes/needles, insulin pump and related supplies) are covered at 100% and must be purchased through a pharmacy in the OptumRx network. For Options 1 & 2, you do not have to meet your annual deductible before coverage begins. With Option 3, coverage begins after you meet your annual deductible.

Continuous glucose monitors (CGMs) and related CGM supplies (for example, the sensor, transmittor and receiver) are available through the medical plan or prescription drug plan and covered at 80%, subject to annual deductible.

Brand/Generic Cost Difference

You are responsible for paying the difference in cost between a generic and brand name drug, plus the co-pay/co-insurance, unless the brand name drug is medically necessary. Amounts paid in excess of the cost of the generic equivalent when a brand name is not medically necessary will not count toward either your annual deductible or out-of-pocket maximum.

Specialty Drugs

Coverage when obtained through your OptumRx prescription drug benefits and OptumRx Specialty Services.

Specialty drugs typically include injectable, infused, oral, or inhaled drugs that generally require special storage or handling and close monitoring of the patient's drug therapy. These drugs are often, but not always, high-cost. Most specialty drugs are used to treat chronic diseases.

GE Health Benefits Options 1 & 2 will not subject these drugs to an annual deductible; however, there is a fixed co-pay of $120 for a 30-day supply, $360 for a 90-day supply (through mail-order). With Option 3, you must meet your annual deductible before these drugs will be covered at the co-pays listed above.

Visit OptumRx for more information

Targeted Drugs

Targeted drugs are generally for specific conditions such as diabetes. For a list of targeted drugs go to optumrx.com

GE Health Benefits Options 1 & 2 will not subject these drugs to an annual deductible and co-insurance maximum; however, there is a fixed co-pay of $12 for a 30-day supply, $24 for a 90-day supply (through mail-order). With Option 3, you must meet your annual deductible before these drugs will be covered at the co-pays listed above.

Visit OptumRx for more information

Preventive and Covered Drugs

Certain over-the-counter (OTC) and prescription drugs prescribed by a doctor will be covered at 100%, based on USPSTF recommendations. Age and gender restrictions apply.

Aspirin to prevent cardiovascular disease (CVD)
Iron supplements in children
Chemoprevention of dental caries (cavities) – Flouride supplementation
Certain tobacco and smoking cessation products for adults
Certain immunizations as recommended by the USPSTF
Colonoscopy prep drugs

Convenience Care Advantage

Receive care at a negotiated rate of $50 per visit at select CVS pharmacies that have a participating convenience care clinic within their location. Visit Convenience Care Advantage to learn more.