Health Plans & Support
Prescription Drugs
Overview
All AEO medical plans provide prescription drug coverage.
Cigna Prescription Drugs
Prescription drug benefits are provided through Express Scripts.
How the Cigna Plans Work
PPO and HRA Plan
There’s no deductible to meet. You pay copays for most drugs, which differ depending on the drug category. For specialty drugs, you pay coinsurance. For the HRA Plan only, you can use your Health Reimbursement Account to help pay for prescriptions.
HSA Plans
If you haven’t met your medical plan deductible, you pay 100% of the cost for prescription drugs. After you meet the deductible, you pay copays, which differ depending on the drug category. For specialty drugs, you pay coinsurance. You can use your Health Savings Account to help pay for care.
All Plans
If you reach your in-network medical out-of-pocket maximum, the plan will pay 100% of your eligible medical and prescription drug expenses for the rest of the plan year.
Filling Your Prescriptions
Short-Term Prescriptions
You can fill short-term prescriptions through retail pharmacies. Find the nearest pharmacy:
Long-Term Prescriptions
If you take maintenance medications for a chronic condition, you’ll be automatically enrolled in the Maintenance Choice program to save you money.
After your second 30-day fill, you’ll be required to get a 90-day supply. You can fill your prescription through the mail-order pharmacy or at a CVS-owned retail pharmacy.
If you want to continue getting 30-day fills, you can opt out of the program. However, you’ll be responsible for the normal 30-day retail pharmacy cost of your prescription.
Cigna Prescription Drug Benefits at a Glance
Here’s a look at what you’ll pay when you fill a prescription.
Note: For the HSA plans, you must meet your deductible first.
| PPO AND HRA PLAN | HRA PLANS | |||||||
|---|---|---|---|---|---|---|---|---|
| RETAIL (UP TO A 30-DAY SUPPLY) | MAIL ORDER (UP TO A 90-DAY SUPPLY) | RETAIL (UP TO A 30-DAY SUPPLY) | MAIL ORDER (UP TO A 90-DAY SUPPLY) | |||||
| Deductible (what you pay first for some services) | ||||||||
| Individual | N/A | Combined with medical | ||||||
| Out-of-Pocket Maximum (the most you have to pay for eligible services) | ||||||||
| Individual/Family | Combined with medical | Combined with medical | ||||||
| You Pay | ||||||||
| Generic | $5 | $10 | $5 after deductible | $10 after deductible | ||||
| Preferred brand | $35 | $70 | $35 after deductible | $70 after deductible | ||||
| Non-preferred brand | $60 | $120 | $60 after deductible | $120 after deductible | ||||
| Specialty – Generic | 10%, $100 maximum | 10% after deductible, $100 maximum | ||||||
| Specialty – Formulary | 20%, $250 maximum | 20% after deductible, $250 maximum | ||||||
| Specialty – Non-formulary | 20% | 20% after deductible | ||||||
Kaiser Permanente Prescription Drugs
Prescription drug benefits will be provided through your Kaiser Permanente plan.
How the Kaiser Permanente Plans Work
All Plans
There’s no deductible to meet. You pay copays for most drugs, which differ depending on the drug category. For specialty drugs, you pay coinsurance.
$2,000 HRA Plan
You can use your Health Reimbursement Account to help pay for prescriptions.
High HDHP and Low HDHP
You can use your Health Savings Account to help pay for prescriptions.
All Plans
If you reach your in-network medical out-of-pocket maximum, the plan will pay 100% of your eligible medical and prescription drug expenses for the rest of the plan year.
Filling Your Prescriptions
Short-Term Prescriptions
You can fill short-term prescriptions through network pharmacies. Find the nearest pharmacy:
Long-Term Prescriptions
If you take maintenance medications for a chronic condition, you can save money by using the mail-order program.
Kaiser Permanente Prescription Drug Benefits at a Glance
Here’s a look at what you’ll pay when you need a prescription filled.
| ALL KAISER PERMANENTE PLANS | ||||
|---|---|---|---|---|
| RETAIL (UP TO A 30-DAY SUPPLY) | MAIL ORDER (UP TO A 90-DAY SUPPLY) | |||
| Deductible (what you pay first for some services) | ||||
| Individual | N/A | |||
| Out-of-Pocket Maximum1 (the most you have to pay for eligible services) | ||||
| Individual/Family | Combined with medical | |||
| You Pay | ||||
| Generic | $101 (Low HDHP: $15) | $201 (Low HDHP: $30) | ||
| Preferred brand | $301 | $601 | ||
| Non-preferred brand | $302 | $602 | ||
| Specialty | 20% up to $250 | Not covered | ||
- No charge for contraceptives
- You pay the same cost for non-preferred brand drugs as for preferred brand drugs when approved through the formulary exception process.
Rx Savings Solutions
If you’re enrolled in an AEO medical plan, you can save money on prescriptions with Rx Savings Solutions. Register for this benefit at myrxss.com. You’ll get suggestions on ways to save, such as:
- Same prescription at a different pharmacy
- Same prescription in a different form (such as capsule or tablet)
- Different prescription that offers the same treatment
FAQs
What’s a generic drug?
Generic drugs have the same active ingredients as brand-name drugs and must meet FDA standards for quality and purity. You usually save the most with generics.
What’s a preferred brand drug?
Certain brand-name drugs are listed on the plan’s formulary (list of preferred prescription drugs). They have been chosen based on safety, quality and cost-effectiveness.
What’s a non-preferred brand drug?
These drugs are not included on the plan’s formulary. You will pay more for non-preferred drugs than for generic and brand drugs.
Where can I find the formulary?
To see the formulary lists for the Cigna plans, visit myCigna.com. For the Kaiser Permanente plans, visit kp.org.
Will I receive a separate prescription drug card?
If you’re enrolled in a Cigna plan, you’ll use the same ID card for medical and prescription drugs. You won’t receive a printed ID card in the mail — you can download an electronic version at myCigna.com.
If you’re enrolled in a Kaiser Permanente plan, you’ll use the same ID card for medical and prescription drugs. You’ll receive an ID card in the mail, and you can also download the KP app to access a digital ID card.
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