What you need to know
When you’re in the market for medicine, you don’t want to waste time or money. Good thing you have prescription coverage—it can make even the most bitter pill a lot easier to swallow. And isn’t this better than a spoonful of sugar? Both UHC (through OptumRx) and Kaiser plans offer convenient home delivery for certain medications.
Ways to save
Who doesn’t like to save a few dollars, especially when it doesn’t involve coupon clipping? Here are some simple ways to save on your prescription purchases:
- Choose lower-cost generic medications over brand-name drugs.
- Use the drug-costing tools on your insurance carrier’s website.
- Use pharmacies in your plan network.
- Take advantage of the mail-order service for maintenance medications.
What you pay: OptumRx (UHC members)
You can get a 30-day supply of medication from retail pharmacies and a 90-day supply through mail order and some retail pharmacies.
Retail pharmacy (in-network, up to 30-day supply)
| UHC PPO | UHC HDHP | |
|---|---|---|
| Zero-cost generic preventive drugs, as defined by ACA* | $0 | $0, no deductible |
| Tier 1, mostly generic | $10 | You pay 10% after deductible |
| Tier 2, preferred brand | $25 | You pay 10% after deductible |
| Tier 3, non-preferred brand and specialty medications | $40 | You pay 10% after deductible |
* Affordable Care Act
Mail-order pharmacy (in-network, 90-day supply)
| UHC PPO | UHC HDHP | |
|---|---|---|
| Zero-cost generic preventive drugs, as defined by ACA* | $0 | $0, no deductible |
| Tier 1, mostly generic | $10 | You pay 10% after deductible |
| Tier 2, preferred brand | $50 | You pay 10% after deductible |
| Tier 3, non-preferred brand | $80 | You pay 10% after deductible |
* Affordable Care Act
What you pay: Kaiser
You can get a 30-day supply of medication from Kaiser pharmacies. Out-of-network prescriptions are only covered in case of an emergency.
Retail pharmacy (in-network, 30-day supply)
| Kaiser CA | Kaiser CO | Kaiser HI | Kaiser WA | Kaiser Mid-Atlantic States | |
|---|---|---|---|---|---|
| Generic | $10 | $10 | $10 | $4 preventative $8 generic | $10 |
| Brand formulary and specialty medications | $25 | $25 | $45 | $25 | $20 |
| Brand non-formulary | N/A | N/A | N/A | N/A | N/A |
Mail-order pharmacy (in-network, up to 100-day supply)
| Kaiser CA | Kaiser CO | Kaiser HI | Kaiser WA | Kaiser Mid-Atlantic States | |
|---|---|---|---|---|---|
| Generic | $20 | $20 | $20 | $20 | $20 |
| Brand formulary | $50 | $50 | $90 | $50 | $40 |
| Brand non-formulary | N/A | N/A | N/A | N/A | N/A |
Please refer to the plan and policy documents for additional details on the plans, including exclusions, limitations and eligibility.