Prescription Benefits

MHBP knows how important prescription drug coverage and pharmacy benefits are — so we’ve got you covered. No matter which MHBP option you have, you’ll have:

Nationwide access to network pharmacies
Coverage for most FDA-approved medications
Low co-payments at network pharmacies for up to a 30-day supply of covered generic medications (Consumer Option members must meet your annual deductible first)
Benefits for mail-order pharmacy to save you even more money—and get up to a 90-day supply
Network benefits for your prescriptions when overseas.

Overview of Plan-Specific Pharmacy Benefits

All MHBP plans include comprehensive prescription drug coverage. This means you can get 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

Standard Option Rx Benefits (No deductible applies)
	Generic – You Pay	Preferred Brand** – You Pay	Non-Preferred Brand** – You Pay	Specialty Drugs † – You Pay	Non-Network and Paper Claims* – You Pay
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	Tier cost share of contracted rate and difference between contracted rate and billed amount
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	N/A- not covered

† 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.

**Specialty drugs are used to treat chronic, complex conditions and typically require special handling and close monitoring.

Value Plan Prescription Drug Coverage and Benefits
	Generic – You Pay	Preferred Brand* – You Pay	Non-Preferred Brand* – You Pay	All Covered Rx—Non-Network Provider and Paper Claims – You Pay
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

*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)

**Specialty drugs are used to treat chronic, complex conditions and typically require special handling and close monitoring.

Consumer Option Prescription Drug Coverage and Benefits
	Generic – You Pay	Preferred Brand Name (Formulary)** – You Pay	Non-Preferred Brand Name (non-formulary) ** – You Pay	Non-Network Pharmacies – You Pay	CVS/caremark Specialty Pharmacy
Annual Deductible	Annual Deductible*	Annual Deductible*	Annual Deductible*	Annual Deductible*	Annual Deductible*
Up to 30-day supply from a network pharmacy	$10 copayment	30% of the Plan’s allowance and any difference between our allowance and the cost of a generic equivalent unless a brand exception is obtained, limited to $200 per prescription	50% of the Plan’s allowance and any difference between our allowance and the cost of a generic equivalent unless a brand exception is obtained, limited to $200 per prescription.	All Charges	20% of the Plan’s allowance, limited to $200 per prescription
Up to 90-day supply through mail order	$20 copayment	$80 copayment per prescription and any difference between our allowance and the cost of a generic equivalent unless a brand exception is obtained	$120 copayment per prescription and any difference between our allowance and the cost of a generic equivalent unless a brand exception is obtained	All Charges	20% of the Plan’s allowance, limited to $425 per prescription

*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)

**Specialty drugs are used to treat chronic, complex conditions and typically require special handling and close monitoring.

Choosing Generic Medications – Are Generic Drugs Really as Good as Brand Names?

You might wonder if generic drugs are as good as brand-name ones. Like many, you might think that generic drugs are lower in quality and not as effective as brand-name drugs. This is not true. Generic drugs are:

Safe and effective – The U.S. Food and Drug Administration (FDA) holds generic drugs to the same standard as their brand-name alternative. They must have the same active ingredients, be equivalent in strength and dosage, and meet the same standards for safety, purity and effectiveness as the original brand-name product.
Cost-effective – You save money when you choose generic drugs over brand-name drugs.

The fact is, generic drugs work just as well as brand-name drugs, but cost less. And generics are available for many brand-name drugs. So when you need a new prescription, ask your doctor if a generic equivalent can be prescribed.

Find a Network Pharmacy

To select “Find a Network Pharmacy” above. Or you can call 1-866-623-1441 (TTY: 711).

Please note: The flu vaccine network covers the influenza vaccine only. The pharmacist will administer the vaccine at the store. Vaccine administration by a pharmacist can vary by state. Please make sure that your selected flu vaccine network pharmacy is permitted to provide this service.