Usa Health Plan Pharmacy Benefit

USA HEALTH PLAN – PHARMACY BENEFIT

The Plan pays 100% of the cost after the member pays a $50 annual deductible and a copay per prescription of $10 for generic, $25 for preferred brand name or $35 for a non-preferred brand name drug. The member pays the copay at the time of purchase and is not required to file a claim.

There have been some questions as to how the benefit works. This information is intended to assist with your understanding of the pharmacy benefit.

1. The $50.00 deductible starts each January 1st.

2. The first $50.00 of prescription drug cost is charged toward the deductible after which the normal copay per prescription applies. The pharmacy’s computer system is linked to the Blue Cross and Blue Shield claims system so the pharmacist should know when the deductible has been met.

3. The $50.00 deductible is limited to 3 per family. So when 3 deductibles have been met during a calendar year no other family members must meet a deductible.

4. After the $50.00 deductible has been met the copay applies to each prescription.

The copay amounts are: Generic $ 10.00 Preferred Brand Name $ 25.00 Non-Preferred Brand Name $ 35.00 Drug Cost is $25 per prescription and the Copay is $10.00

1 st Purchase Drug Cost $ 25.00 Copay $ 10.00 No copay applies because the cost of the drug applies toward the deductible. Applied to Deductible $ 25.00 Remaining Deductible $ 25.00 Your Cost $ 25.00

2 nd Purchase Drug Cost $ 25.00 Copay $ 10.00 No copay applies because the cost of the drug applies toward the deductible. Applied to Deductible $ 25.00 Remainder Deductible $ 0 Your Cost $ 25.00

3 rd Purchase Drug Cost $ 25.00 Copay $ 10.00 Applied to Deductible $ 0 Deductible has been met. Your Cost $ 10.00 You will only pay the copay since you satisfied the deductible with the first two purchases. Drug Cost is $25 per prescription and the Copay is $25.00

1 st Purchase Drug Cost $ 25.00 Copay $ 25.00 No copay applies because the cost of the drug applies toward the deductible. Applied to Deductible $ 25.00 Remaining Deductible $ 25.00 Your Cost $ 25.00

2 nd Purchase Drug Cost $ 25.00 Copay $ 25.00 No copay applies because the cost of the drug applies toward the deductible. Applied to Deductible $ 25.00 Remainder Deductible $ 0 Your Cost $ 25.00

3 rd Purchase Drug Cost $ 25.00 Copay $ 25.00 Applied to Deductible $ 0 Deductible has been met. Your Cost $ 25.00 You will only pay the copay since you satisfied the deductible with the first two purchases. Drug Cost is $25 per prescription and the Copay is $35.00

1 st Purchase Drug Cost $ 25.00 Copay $ 35.00 No copay applies because the cost of the drug applies toward the deductible and you will not pay more than the cost of the drug to satisfy a copay. Applied to Deductible $ 25.00 Remaining Deductible $ 25.00 Your Cost $ 25.00

2 nd Purchase Drug Cost $ 25.00 Copay $ 35.00 No copay applies because the cost of the drug applies toward the deductible and you will not pay more than the cost of the drug to satisfy a copay. Applied to Deductible $ 25.00 Remaining Deductible $ 0 Your Cost $ 25.00

3 rd Purchase Drug Cost $ 25.00 Copay $ 35.00 Applied to Deductible $ 0 Deductible has been met. Your Cost $ 25.00 You will not pay more than the cost of the drug to satisfy a copay. Drug Cost is $60 per prescription and the Copay is $10.00

1 st Purchase Drug Cost $ 60.00 Copay $ 10.00 Generic Drug Copay.

Applied to Deductible $ 50.00 Remaining Deductible $ 0 Deductible has been met. Your Cost $ 60.00 $50 Deductible plus $10 copay.

2 nd Purchase Drug Cost $ 60.00 Copay $ 10.00 Generic Drug Copay.

Remaining Deductible 0 Your Cost $ 10.00 Copay applies since the deductible has been met.

3 rd Purchase Drug Cost $ 60.00 Copay $ 10.00 Generic Drug Copay. Applied to Deductible $ 0 Deductible has been met. Your Cost $ 10.00 Copay applies since the deductible has been met. Drug Cost is $60 per prescription and the Copay is $25.00

1 st Purchase Drug Cost $ 60.00 Copay $ 25.00 Preferred Brand Name drug.

Applied to Deductible $ 50.00 Remaining Deductible $ 0 Your Cost $ 60.00 You will pay the cost of the drug since the copay plus deductible ($75) will exceed the cost of the drug.

2 nd Purchase Drug Cost $ 60.00 Copay $ 25.00 Preferred Brand Name drug.

Remaining Deductible $ 0 Your Cost $ 25.00 Copay applies since the deductible has been met.

3 rd Purchase Drug Cost $ 60.00 Copay $ 25.00 Preferred Brand Name drug. Remaining Deductible $ 0 Your Cost $ 25.00 Copay applies since the deductible has been met. Drug Cost is $60 per prescription and the Copay is $35.00

1 st Purchase Drug Cost $ 60.00 Copay $ 35.00 No copay applies because the cost of the drug applies toward the deductible. Applied to Deductible $ 50.00 Remaining Deductible $ 0 Your Cost $ 60.00 You will pay the cost of the drug since the copay plus deductible ($85) will exceed the cost of the drug.

2 nd Purchase Drug Cost $ 60.00 Copay $ 35.00 Non-Preferred Brand Name drug.

Remaining Deductible $ 0 Your Cost $ 35.00 Copay applies since the deductible has been met.

3 rd Purchase Drug Cost $ 60.00 Copay $ 35.00 Non-Preferred Brand Name drug. Applied to Deductible $ 0 Deductible has been met. Your Cost $ 35.00 Copay applies since the deductible has been met. Drug Cost is $200 per prescription and the Copay is $10.00

1 st Purchase Drug Cost $ 200.00 Copay $ 10.00 Generic drug.

Applied to Deductible $ 50.00 Remaining Deductible $ 0 Your Cost $ 60.00 $50 deductible plus $10 copay.

2 nd Purchase Drug Cost $ 200.00 Copay $ 10.00 Generic drug.

Remaining Deductible $ 0

Your Cost $ 10.00 Copay applies since the deductible has been met.

3 rd Purchase Drug Cost $ 200.00 Copay $ 10.00 Generic drug. Applied to Deductible $ 0 Deductible has been met. Your Cost $ 10.00 Copay applies since the deductible has been met. Drug Cost is $200 per prescription and the Copay is $25.00

1 st Purchase Drug Cost $ 200.00 Copay $ 25.00 Preferred Brand Name drug.

2 nd Purchase Drug Cost $ 200.00 Copay $ 25.00 Preferred Brand Name drug.

3 rd Purchase Drug Cost $ 200.00 Copay $ 25.00 Preferred Brand Name drug.

Applied to Deductible $ 0 Deductible has been met. Your Cost $ 25.00 Copay applies since the deductible has been met. Drug Cost is $200 per prescription and the Copay is $35.00

1 st Purchase Drug Cost $ 200.00 Copay $ 35.00 Non-Preferred Brand Name drug.

2 nd Purchase Drug Cost $ 200.00 Copay $ 35.00 Non-Preferred Brand Name drug.

3 rd Purchase Drug Cost $ 200.00 Copay $ 35.00 Non-Preferred Brand Name drug.

Applied to Deductible $ 0 Deductible has been met. Your Cost $ 35.00 Copay applies since the deductible has been met.