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.

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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 PPOUHC HDHP
Zero-cost generic preventive drugs, as defined by ACA*$0$0, no deductible
Tier 1, mostly generic$10You pay 10% after deductible
Tier 2, preferred brand$25You pay 10% after deductible
Tier 3, non-preferred brand and specialty medications$40You pay 10% after deductible

* Affordable Care Act

Mail-order pharmacy (in-network, 90-day supply)

 UHC PPOUHC HDHP
Zero-cost generic preventive drugs, as defined by ACA*$0$0, no deductible
Tier 1, mostly generic$10You pay 10% after deductible
Tier 2, preferred brand$50You pay 10% after deductible
Tier 3, non-preferred brand$80You pay 10% after deductible

* Affordable Care Act

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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 CAKaiser COKaiser HIKaiser WAKaiser
Mid-Atlantic States
Generic$10$10$10$4 preventative
$8 generic
$10
Brand formulary and specialty medications$25$25$45$25$20
Brand non-formularyN/AN/AN/AN/AN/A

 

Mail-order pharmacy (in-network, up to 100-day supply)

 Kaiser CAKaiser COKaiser HIKaiser WAKaiser
Mid-Atlantic States
Generic$20$20$20$20$20
Brand formulary$50$50$90$50$40
Brand non-formularyN/AN/AN/AN/AN/A

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Please refer to the plan and policy documents for additional details on the plans, including exclusions, limitations and eligibility.