How Prescription Benefits Work
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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:
- Always choose a network pharmacy. Find participating pharmacies.
- 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.
- 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:
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