Page 8 - 2015/2016 Benefits Guide
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Prescription Drug Coverage
Prescription Drugs
There are different copayments that apply based on the type of drugs you
are requesting. Maintenance drugs are eligible to be illed at the Home
Delivery Pharmacy. Employees are allowed to ill up to a 90 day supply
with three reills at two times the retail price.
Specialty drugs are complex and costly injectable, oral or infused
medications used to treat chronic conditions. Members are allowed to ill
the irst prescription at a local pharmacy and then are directed to reill
through CuraScript Pharmacy.
In addition, compound drugs are covered under coinsurance. Compound
drugs, which require a doctor’s prescription, are prepared by a pharmacist
who mixes or adjusts drug ingredients to customize a medication to meet
an individual’s needs.
Prescription Drug Coverage (Premium and Basic Plans)
Retail Network Pharmacy—Up to 31-Day Supply
Generic < $500 $10
Generic > $500 $50
Preferred brand 20%, $35 minimum, $50 maximum
Non-preferred brand 30%, $50 minimum, $75 maximum
Mail Order—90-Day Supply
Generic < $1,000 $20
Generic > $1,000 $100
Preferred brand 20%, $70 minimum, $100 maximum
Non-preferred brand 30%, $100 minimum, $150 maximum
CuraScript Specialty Pharmacy
Specialty drugs 20%, $150 maximum
Pharmacy Out-of-Pocket Maximum (In-Network Only)
July 1, 2015 to January 1, 2016 to
December 31, 2015 June 30, 2016
Premium $2,475 per individual and $2,475 per individual and
$4,950 per family $4,950 per family
Basic $2,225 per individual and $2,225 per individual and
$4,450 per family $4,450 per family
Prescription Drug coverage under the HSA plan is subject to the
deductible then coinsurance.
TheBANK of Edwardsville
Prescription Drug Coverage
Prescription Drugs
There are different copayments that apply based on the type of drugs you
are requesting. Maintenance drugs are eligible to be illed at the Home
Delivery Pharmacy. Employees are allowed to ill up to a 90 day supply
with three reills at two times the retail price.
Specialty drugs are complex and costly injectable, oral or infused
medications used to treat chronic conditions. Members are allowed to ill
the irst prescription at a local pharmacy and then are directed to reill
through CuraScript Pharmacy.
In addition, compound drugs are covered under coinsurance. Compound
drugs, which require a doctor’s prescription, are prepared by a pharmacist
who mixes or adjusts drug ingredients to customize a medication to meet
an individual’s needs.
Prescription Drug Coverage (Premium and Basic Plans)
Retail Network Pharmacy—Up to 31-Day Supply
Generic < $500 $10
Generic > $500 $50
Preferred brand 20%, $35 minimum, $50 maximum
Non-preferred brand 30%, $50 minimum, $75 maximum
Mail Order—90-Day Supply
Generic < $1,000 $20
Generic > $1,000 $100
Preferred brand 20%, $70 minimum, $100 maximum
Non-preferred brand 30%, $100 minimum, $150 maximum
CuraScript Specialty Pharmacy
Specialty drugs 20%, $150 maximum
Pharmacy Out-of-Pocket Maximum (In-Network Only)
July 1, 2015 to January 1, 2016 to
December 31, 2015 June 30, 2016
Premium $2,475 per individual and $2,475 per individual and
$4,950 per family $4,950 per family
Basic $2,225 per individual and $2,225 per individual and
$4,450 per family $4,450 per family
Prescription Drug coverage under the HSA plan is subject to the
deductible then coinsurance.
TheBANK of Edwardsville
