Prescription Plan
All medical plan participants have prescription drug coverage based on their selected plan. A way to save money is by requesting generics and/or mail order options when available.
Prescription Plan - HMO
| California Care HMO Value Deductible | Priority Select HMO Classic | Vivity HMO Value Deductible | ||||
|---|---|---|---|---|---|---|
| Annual Pharmacy Deductible | ||||||
| (Individual/Family) | None | None | None | |||
| Annual Pharmacy Out-of-Pocket Maximum | ||||||
| (Individual / Family) | Medical OOPM applies | Medical OOPM applies | Medical OOPM applies | |||
| Retail Network (Up to a 31-day supply) | ||||||
| Tier 1 (a/b) | $5/$20 | $5/$20 | $5/$20 | |||
| Tier 2 | $50 | $40 | $50 | |||
| Tier 3 | $75 | $60 | $75 | |||
| Tier 4 – Specialty | 30% coins (max $250) | 30% coins (max $250) | 30% coins (max $250) | |||
| Mail Order Pharmacy (Up to a 90-day supply) | ||||||
| Tier 1 (a/b) | $10/$40 Copay | $10/$40 Copay | $10/$40 Copay | |||
| Tier 2 | $125 Copay | $100 Copay | $125 Copay | |||
| Tier 4 – Specialty | 30% coins (max $250) | 30% coins (max $250) | 30% coins (max $250) | |||
| Tier 3 | $188 Copay | $150 Copay | $188 Copay | |||
Prescription Plan - PPO
| Prudent Buyer PPO Solution | Prudent Buyer PPO HSA | |||
|---|---|---|---|---|
| Annual Pharmacy Deductible | ||||
| (Individual/Family) | None | None | ||
| Annual Pharmacy Out-of-Pocket Maximum | ||||
| (Individual / Family) | None | None | ||
| Retail Network (Up to a 31-day supply) | ||||
| Tier 1 (a/b) | $5/$20 | $5/$15* | ||
| Tier 2 | $40 | $40 | ||
| Tier 3 | $60 | $60 | ||
| Tier 4- Specialty | 30% coins (max $250) | 30% coins (max $250)* | ||
| Mail Order Pharmacy (Up to a 90-day supply) | ||||
| Tier 1 (a/b) | $10/$40 Copay | $10/$30 Copay | ||
| Tier 2 | $100 Copay | $100 Copay | ||
| Tier 3 | $150 Copay | $150 Copay | ||
| Tier 4 – Specialty | 30% coins (max $250) | 30% coins (max $250)* | ||
| *After Deductible | ||||
What is a drug tier? How does it work?
Prescription Drug Lists often have tiers, or groups of drugs categorized by cost. Your cost-share or copayment is based on which tier your drug is in.
Tier 1: Least expensive drug options, often generic drugs
Tier 2: Higher price generic and lower-price brand-name drugs
Tier 3: Mainly higher price brand-name drugs
What’s the difference between brand and generic drugs?
A brand-name drug is the name given to the medication by the company that makes the drug. A generic drug is chemically identical – a copy of the brand-name drug. The two are considered bioequivalent and expected to do the same thing for you.
Generic drugs can be:
- As effective as brand-name drugs*
- Often less expensive than brand-name drugs*
- Different than brand-name drugs mainly based on inactive ingredients, the ingredients that change the consistency, color or taste – but not the chemical activity – of the drug**