27 HEALTH AND WELLNESS Prescription Drugs Scripps HMO Option Scripps EPO Option Annual Out-of-Pocket Prescription Drugs Maximum $3,000 per person; $5,500 per family $4,150 per person; $8,300 per family Retail • Generic • High Cost Generic • Preferred/Formulary • Non-Preferred/Non-Formulary • Specialty Medications 30-day supply $20 copay $50 copay $50 copay $90 copay 30% coinsurance ($125 min, $300 max) 30-day supply $20 copay $50 copay $50 copay $90 copay 30% coinsurance ($125 min; $250 max) if you live and work outside San Diego County or, 30% coinsurance ($125 min; $300 max) if you live or work in San Diego County Mail Service • Generic • High Cost Generic • Preferred/Formulary • Non-Preferred/Non-Formulary 90-day supply $40 copay $125 copay $125 copay $270 copay 90-day supply $40 copay $125 copay $125 copay $270 copay Prescription Drug Program When you enroll in either Scripps Medical Plan option, you are automatically covered under the Prescription Drug Program. Prescription Drug Copays and Annual Out-of-Pocket Maximum Save Money With Generic Drugs A generic drug can have the lowest copay. If you elect a brand medication when a generic medication is available, you will pay the price difference between the brand medication and the generic medication, plus the brand copay. Generic Drugs: These drugs are sold under the drug’s chemical name and contain the same active ingredients and equivalent strength and dosage to the brand-name equivalent. High Cost Generic Drugs: Generic drugs costing over $50 that have a relevant alternative. Preferred/Formulary Drugs: You pay a lower copay for preferred brand drugs on the drug formulary compared to non-preferred drugs that are not on the drug formulary. Non-Preferred/Non-Formulary Drugs: You pay the highest copay for non-preferred brand drugs that are not on the drug formulary. Specialty Medications: Specialty medications provide highly sophisticated treatment for certain rare or chronic conditions. All specialty medications, including compound drugs costing more than $400, require a prior authorization; have your physician contact MedImpact at 844-282-5343 (HMO option) or 800-788-2949 (EPO option).
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