Health plan participants (members and dependents) are required to pay a prescription deductible each plan year.
Plan participants enrolled in any of the State health plans have prescription drug coverage included in their health plan benefits. Prescription benefits are administered by the health plan's prescription benefit manager (PBM). Members who use the PBMs pharmacy network to obtain their medication will be charged the applicable prescription copayment after the prescription deductible has been met. A pharmacy that is not in the network may charge more than the copayment amount; therefore, members should verify that a pharmacy is in network in order to avoid high prescription costs.
Plan participants enrolled in HealthLink OAP, Coventry Health Care OAP or the Quality Care Health Plan have specific policies, as well as maintenance and nonmaintenance prescription networks they should be aware of prior to selecting a pharmacy. Participants may view the Express Scripts formulary list for their plan by using the following link:
Plan participants enrolled in BlueAdvantage HMO, Health Alliance HMO, Coventry Health Care HMO and HMO Illinois may also receive a discount when they fill a 90-day supply of medication. Plan participants enrolled in one of these plans should contact their health plan for information regarding discounts and formulary lists. Note: Effective July 1, 2013, a 90-day supply of medication will be 2.5 times the copayment amount when ordered through the plan's mail order pharmacy. Some HMO plans also offer the 2.5 copayment discount for a 90-day supply filled at a retail pharmacy. Check with your HMO to determine if your plan offers a 90-day supply through a retail pharmacy.
Effective July 1, 2013: Under the Affordable Care Act, Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs, will be covered by the plan without cost-sharing requirements.