Page 14 - QSC EE Guide 01-20 CA

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
Save time and money by having your maintenance prescription medications sent directly
to your home. The Cigna Rx Home Delivery program allows you to receive a 90-day supply
for only 2 copayments. For example, a generic 3 month supply at the retail pharmacy
would cost you $30, but by utilizing Cigna Rx Home Delivery, your prescription would cost
you $20. That is a 33% savings!

Plan Name Cigna Cigna Cigna Cigna
HSA PPO HMO Select HMO Full PPO
Network Open Non- Select Full Open Non-
Name Access Plus Network Access Plus Network
Deductible Health Not Covered $0 $0 $0 Not Covered
Deductible

Retail Pharmacy
Generic $10 Copay Not Covered $10 Copay $15 Copay $15 Copay Not Covered
Brand Name $25 Copay Not Covered $25 Copay $30 Copay $30 Copay Not Covered
Non-Formulary $50 Copay Not Covered $50 Copay $50 Copay $50 Copay Not Covered
Supply Limit 30 Days N/A 30 Days 30 Days 30 Days N/A

Mail Order Pharmacy
Generic $20 Copay Not Covered $20 Copay $30 Copay $30 Copay Not Covered
Brand Name $50 Copay Not Covered $50 Copay $60 Copay $60 Copay Not Covered
Non-Formulary $100 Copay Not Covered $100 Copay $100 Copay $100 Copay Not Covered
Supply Limit 90 Days N/A 90 Days 90 Days 90 Days N/A
Specialty
Pharmacy 20% to $250 Not Covered 20% to $100 20% to $100 20% to $250 Not Covered
Supply Limit 30 Days N/A 30 Days 30 Days 30 Days N/A
Mail Order 20% to $250 Not Covered 20% to $300 20% to $300 20% to $250 Not Covered
Supply Limit 30 Days N/A 90 Days 90 Days 30 Days N/A

Pharmacy Tips

Use generic and over the counter drugs when available
The best way to save on prescription drugs is to use generic or over the
counter medications as opposed to brand name medications when possible.
When you use generic medications, you will pay the lowest copay.

Use the discount prescription drug programs offered at Costco,
Walmart, GoodRx, One Rx, and other retailers
You may receive a deeper discount than you would if you used our insurance
plans offered through Cigna.