HealthChoice Pharmacy Copay Structure
Current and Pre-Medicare Members
|HealthChoice High*, High Alternative*, Basic, Basic Alternative,
USA plans and High Deductible Health Plan (HDPD**)
||Up to a 30-Day Supply of a Medication
||31- to 90-Day Supply of a Medication
||Up to $10 copay
||Up to $25 copay
||Up to $45 copay
||Up to $90 copay
||Up to $75 copay
||Up to $150 copay
||Generic – $10 copay Preferred – $100 copay Non-preferred – $200 copay
||Specialty medications are covered only for up to a 30-day supply
Pharmacy deductible —
*HealthChoice High and High Alternative plan members must meet the pharmacy deductible of $100 per individual/$300 maximum per family before benefits are available.
**HDHP members must meet the combined medical and pharmacy deductible ($1,500 individual/$3,000 family) before benefits are available.
***Specialty medications are covered only when ordered through the CVS/caremark specialty pharmacy.
Medications on the HealthChoice Preventive Medication List are not subject to the deductible. Copays apply to the pharmacy out-of-pocket maximum, but not the deductible.
For questions regarding the benefits under the pharmacy plan, please contact the pharmacy benefit manager toll-free at 877-720-9375. TDD users call 711.