Prescription Drug Changes
Prescription Drug Changes
Prescription Benefit Copays Administered by MedImpact
- $6 copay (1-30 day supply)
- $12 copay (31-90 day supply)
Formulary (preferred brand name):
- $40 copay (1-30 day supply)
- $80 copay (31-60 day supply)
- $120 copay (61-90 day supply)
Non-formulary (non-preferred brand name):
- $60 copay (1-30 day supply)
- $120 copay (31-60 day supply)
- $180 copay (61-90 day supply)
Pharmacists must dispense a generic equivalent medication when one is available unless the physician indicates on the prescription “medically necessary”, “dispense as written”, or “do not substitute”.
Approved Maintenance drugs must be on the approved maintenance list of drugs and must be prescribed for 90 days. First fill for a new maintenance drug will be a 30-day supply.
DAW (Dispense as Written) Cost Differential: Members will be subject to the difference between the cost of the brand drug and its generic equivalent, regardless of whether the physician indicates the brand must be taken.
Specialty Drugs – 4th Tier: Members are responsible to pay the 20% coinsurance with a minimum copay of $100 and maximum copay of $150. The DAW cost differential applies for multi-source brand drugs with a generic chemical equivalent.
Certain prescription drugs and medications are excluded from PEEHIP coverage. To verify the formulary and coverage status of a medication, please visit the MedImpact website at https://mp.medimpact.com/ala.
Contraceptives are covered. $0 copay-Generic; applicable copay for brand-name.
Flu vaccine covered at no cost when administered by a participating retail pharmacy.
Certain medications have quantity level limits to comply with the FDA guidelines and to ensure drug safety for our members. Certain medications are subject to Step Therapy. Prior authorizations are required before covered members can receive certain medications.
In-state and out-of-state non-participating pharmacies: Members must pay the full amount of the prescription and then file the claim to be reimbursed at the participating pharmacy rate. Members pay the difference in cost plus appropriate copayments. All PEEHIP clinical utilization management programs will apply. Out-of-pocket expenses will be higher if you use a non-participating pharmacy.
Medicare-eligible retired members and Medicare-eligible covered dependents will be provided prescription drug coverage through the UnitedHealthcare® Group Medicare Advantage (PPO) plan for PEEHIP retirees.
Visit www.uhcretiree.com/peehip for more information.