Plan participants enrolled in any LGHP health plan have prescription drug benefits included in the coverage. All prescription medications are compiled on a preferred drug list ("formulary list") maintained by each health plan's prescription benefit manager (PBM). Formulary lists categorize drugs in four levels: Reduced Tier 1, Tier1, Tier 2 and Tier 3 brands. Each level has a different copayment amount. Coverage for specific drugs may vary depending upon the health plan. It is important to note that formulary lists are subject to change any time during the plan year. To compare formulary lists, cost-savings programs and to obtain a list of pharmacies that participate in the various health plan networks, plan participants should visit the website of each health plan they are considering.
Plan participants who have additional prescription drug coverage, including Medicare, should contact their plan’s PBM for coordination of benefits (COB) information.
Plan participants enrolled in
HealthLink OAP, Aetna OAP, Local Consumer-Driven Health Plan (LCDHP) or the
Local Care Health Plan (LCHP), have CVS/caremark as their PBM.
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.
(Effective July 1, 2019)
FY20 LGHP Prescription Copayments
|Generic||$15.00||$15.00||Member pays 30% coinsurance|
|Preferred Brand||$30.00||$30.00||Member pays 50% coinsurance|
|Non-Preferred Brand||$60.00||$60.00||Member pays 50% coinsurance|
FY21 LGHP Prescription Copayments (Effective July 1, 2020)
*Reduced Tier I||
OAPs||30-day supply||-||$15.00 copay; Deductible applies||$30.00 copay; Deductible applies||$60.00 copay; Deductible applies||$120.00 copay; Deductible applies|
|90-day supply||-||$30.00 copay; Deductible applies||$60.00 copay; Deductible applies||$120.00 copay; Deductible applies||-|
|-||$15.00 copay; Deductible applies||$30.00 copay; Deductible applies||$60.00 copay; Deductible applies||-|
* Applies to specific medications as defined by plan.
**Medications received at CVS Caremark® Pharmacy or through CVS Caremark® Mail Service Pharmacy
Last Updated 05/01/2020