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How Prescription Benefits Work

3 Ways to Save on Prescription Drugs

No matter what prescription plan you’re on, you can save time and money by doing these three things:

  1. Always choose a network pharmacy. Find participating pharmacies.
  2. Show your ID card to your pharmacist when you get a prescription filled. Your network pharmacist will submit your bill for you. Never send in a paper claim form unless the pharmacist instructs you to do so.
  3. Choose generics whenever possible. Ask your physician whether the drug he or she is prescribing for you is generic.  If it isn't, ask whether a generic equivalent drug is available.

How Tiered Plans Work

If you’re enrolled in a prescription drug plan that uses tiers, how much you pay for a prescription depends on a drug’s tier. The higher the tier number, the higher your copayment or coinsurance.

 

2-tier plans have two levels of payment:

  • Tier 1: You have the lowest cost share for generic drugs
  • Tier 2:  You have the highest cost share for brand-name drugs

3-tier plans have 3 levels of payment:

  • Tier 1: You have the lowest cost share for generic drugs
  • Tier 2: You have an intermediate cost share for specially selected brand-name drugs
  • Tier 3: You have the highest cost share for all other brand-name drugs

4-tier plans have 4 levels of payment:

  • Tier 1: You have the lowest cost share for generic drugs
  • Tier 2: You have an intermediate cost share for selected brand-name drugs
  • Tier 3: You have a higher cost share for selected brand-name drugs
  • Tier 4: You have the highest cost share for other selected brand-name drugs

Pharmacy Benefits as Part of Comprehensive Major Medical (CMM) Plans

If you are enrolled in a comprehensive major medical plan, your health plan’s deductible, coinsurance, and/or copayment apply to your prescription drugs.

  • You pay the pharmacist for the cost of the prescription, and the pharmacist submits the claim for you.
  • Wellmark then sends you reimbursement by mail for covered prescription drug expenses, less your deductible and coinsurance amounts.

To learn more about your specific prescription benefits:

  • Refer to your coverage manual or policy
  • Call the Customer Service number on your ID card
  • Register for myWellmark and log in to check your:
    • cost share for prescriptions
    • price you’ll pay for specific medications
    • prescription history


Related Information
»   Locate a Pharmacy open new window image
»   Download Forms
»   Prior Authorization open new window image
»   Quantity Limits open new window image
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