Pharmacy Benefits Summary

Section Banner Image

Overview of Plan-Specific Pharmacy Benefits

All MHBP plans include comprehensive prescription drug coverage with access to nationwide network pharmacies, low copays for generic medications, and mail-order pharmacy services. Below is a plan-by-plan comparison of our prescription drug coverage and pharmacy benefits along with the out-of-pocket costs for prescription drugs under each plan.

Standard Option Prescription Drug Coverage and Benefits

† Specialty drugs are used to treat chronic, complex conditions and typically require special handling and close monitoring. Specialty drugs must be obtained from CVS Caremark Specialty Pharmacy.

*50% of the Plan's allowance and any difference between our allowance and the billed amount. This does not apply to Specialty drugs.
** You will pay the copayment or coinsurance amount and the difference in cost between our allowance for the generic and brand name drug when a generic is available, unless a brand exception is obtained.

Standard Option Rx Benefits (No deductible applies) You Pay Generic Preferred Brand** Non-Preferred Brand** Specialty Drugs † All Covered Rx—Non-Network and Paper Claims
Standard Option Rx Benefits (No deductible applies)
Topic You Pay
Topic Generic Preferred Brand** Non-Preferred Brand** Specialty Drugs † All Covered Rx—Non-Network and Paper Claims
Up to 30-day supply from a network pharmacy $5 copay

30% of the Plan's allowance, limited to $200 per prescription

50% of the Plan's allowance, limited to $200 per prescription

15% of the Plan's allowance, limited to $200 per prescription

*50%
Up to 90-day supply through mail order (Caremark for Specialty) $10 copay $80 copay $120 copay

15% of the Plan's allowance, limited to $425 per prescription

All charges

Value Plan Prescription Drug Coverage and Benefits


*You will pay the copayment or coinsurance amount and the difference in cost  between our allowance for the generic and brand name drug when a generic is available, unless  a brand exception is obtained.

Value Plan Rx Benefits (No deductible applies) You Pay Generic Preferred Brand*

Non-Preferred Brand*

All Covered Rx—Non-Network Provider and Paper Claims
Value Plan Rx Benefits (No deductible applies)
Topic You Pay
Topic Generic Preferred Brand*

Non-Preferred Brand*

All Covered Rx—Non-Network Provider and Paper Claims
Up to 30-day supply from a network pharmacy $10 copay 45% of the Plan's allowance

75% of the Plan's allowance

All charges
Up to 90-day supply through mail order $30 copay 45% of the Plan's allowance

75% of the Plan's allowance

All charges

Consumer Option Prescription Drug Coverage and Benefits

*The annual deductible of $2,000 per person/$4,000 per family for medical and Rx expenses combined applies to all services except preventive care.

**You will pay the copayment or coinsurance amount and the difference in cost  between our allowance for the generic and brand name drug when a generic is available, unless  a brand exception is obtained.

Consumer Option Rx Benefits (Annual deductible applies) You Pay Generic Preferred Brand** Non-Preferred Brand** Non-Network Provider and Paper Claims
Consumer Option Rx Benefits (Annual deductible applies)
Topic You Pay
Topic Generic Preferred Brand** Non-Preferred Brand** Non-Network Provider and Paper Claims
Annual Deductible Annual Deductible* Annual Deductible* Annual Deductible* Annual Deductible*
Up to 30-day supply from a network pharmacy $10 copay $25 copay $40 copay Not Covered
Up to 90-day supply through mail order $20 copay $50 copay $80 copay Not Covered