Page 14 - Tender Greens EE Guide 01-20

The Blue Shield medical plans include prescription drug coverage for you and your covered dependents.

Retail Pharmacy
Use a retail pharmacy to fill prescriptions for acute conditions (conditions that do not require the
medication to be taken on a regular basis). At a participating pharmacy, you will receive up to a 30
day supply of your prescriptions.

Mail Order Pharmacy – Maintenance Medication
You could pay less for the same medication when you use the mail order pharmacy. The mail order
pharmacy is a fast, easy and convenient way to save time and money on your maintenance
medications (drugs that you need to take regularly). You can order additional supplies of
medication at a discount. See below for details!

Blue Shield Blue Shield Blue Shield

Plan Name HMO PPO HDHP PPO
SaveNet or

Network Name Access+ HMO Full PPO Non-Network Full PPO Non-Network
Deductible $150/Member Health Ded Health Ded $0 $0
Retail Pharmacy

Tier 1: Generic $15 Ded, $10 Ded, $10 + 25% $15 $15 + 25%
Tier 2: Brand Name Ded, $30 Ded, $25 Ded, $25 + 25% $30 $30 + 25%
Tier 3: Non-Formulary Ded, $45 Ded, $40 Ded, $40 + 25% $45 $45 + 25%
Tier 4: Specialty Ded, 20% Max $200 Ded, 30% Max Ded, 30% to 30% Max $200 30% to $200 +
$200 $200 + 25% 25%
Supply Limit 30 Days 30 Days 30 Days 30 Days 30 Days
Mail Order Pharmacy
Tier 1: Generic $30 Ded, $20 Not Covered $30 Not Covered
Tier 2: Brand Name Ded, $60 Ded, $50 Not Covered $60 Not Covered
Tier 3: Non-Formulary Ded, $90 Ded, $80 Not Covered $90 Not Covered
Tier 4: Specialty Ded, 20% Max $400 Ded, 30% Max Not Covered 30% Max $400 Not Covered
$400

Supply Limit 90 Days 90 Days N/A 90 Days N/A

Pharmacy Tips

Use generic and over the counter drugs when available.
The best way to save on prescriptions is to use generic or over the counter medications as
opposed to brand name drugs. Generic drugs must use the same active ingredients as the
brand name version of the drug. A generic drug must also meet the same quality and
safety standards.

Use the mail order benefit for maintenance medications.
To save money and time, consider using the mail order pharmacy to fill your maintenance
medications.

14 Team Member Benefits