Page 14 - QSC EE Guide 07-19 Remote
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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
                                                 HSA PPO                                      PPO
                                         Open
                                                                                   Open
         Network Name                 Access Plus        Non-Network            Access Plus       Non-Network
         Deductible                      Health           Not Covered                $0             Not Covered
                                       Deductible

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

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