Your costs for covered prescription drugs

​Prescription drug benefits are automatically included with medical coverage through the Board of Pensions at no additional cost. You share in the cost of medically necessary drugs prescribed for you and your enrolled family members.

Prescription drug benefits help with the cost of medications prescribed to maintain or restore health, or to treat ongoing health conditions. Your out-of-pocket cost for covered drugs varies depending on

  • which medical option you are enrolled in (PPO, EPO, or HDHP);
  • whether the drug is on the preventive drug list;
  • the drug type (generic, formulary, or non-formulary); and
  • whether you fill your prescription at a retail pharmacy or through the plan’s mail service.

If a brand-name medication is used when an equivalent generic exists, you will be responsible for the cost difference between the brand-name and the generic in addition to the applicable copayment.

Under the HDHP, note that your annual deductible applies when filling prescriptions for covered non-preventive drugs. If you set up a health savings account (HSA), you can use funds in your HSA to help pay for out-of-pocket prescription drug costs.

For the PPO and EPO, if your employer offers a healthcare flexible spending account (FSA), you may be able to pay for out-of-pocket costs for prescriptions from your FSA.

Note: The EPO and HDHP do not cover non-formulary drugs. If you are enrolled in one of these options and you fill a prescription for a brand-name drug that is not on the formulary, you pay 100 percent of the drug cost.

How much you pay

Review prescription drug costs for the medical option in which you are enrolled:

PPO costs

​Benefit​PPO
​Preventive prescription drugs generic retail (30/90 days)​$5/$15
​Preventive prescription drugs generic mail order (90 days)​$12.50
​Preventive prescription drugs formulary brand retail (30/90 days)​$20/$60
​Preventive prescription drugs formulary brand mail order (90 days)​$50
​Generic retail (30/90 days)​$10/$30
​Generic mail (90 days)​$25
​Formulary brand retail (30/90 days)

​30% of cost
30 days: $20 min to $100 max
90 Days: $60 min to $300 max

​Formulary brand mail (90 days)​30% of cost
$50 min to $250 max
​Non-formulary brand retail (30/90 days)​50% of cost
30 days: $50 min to $150 max
90 days: $150 min to $450 max
​Non-formulary brand mail (90 days)​50% of cost
$125 min to $375 max
​Prescription out-of-pocket maximum
(excluding non-formulary brand-names)
​$3,000 (member & family combined)
​Medical out-of-pocket maximumLowest salary band: ​$2,200/family*
Highest salary band: $4,340/family*
​Total maximum out-of-pocket$5,000/member; $10,000/family**

EPO costs

​Benefit​EPO
​Preventive prescription drugs generic retail (30/90 days)​$6/$18
​Preventive prescription drugs generic mail order (90 days)​$15
​Preventive prescription drugs formulary brand retail (30/90 days)​$30/$90
​Preventive prescription drugs formulary brand mail order (90 days)​$75
​Generic retail (30/90 days)​$12/$36
​Generic mail (90 days)​$30
​Formulary brand retail (30/90 days)

​35% of cost
30 days: $35 min to $150 max
90 days: $105 min to $450 max

​Formulary brand mail (90 days)​35% of cost
$85 min to $375 max
​Non-formulary brand retail and mail ​Not covered
​Prescription and medical out-of-pocket maximumPart of the total maximum out-of-pocket

Total maximum out-of-pocket

$5,000/member; $10,000/family**

HDHP costs

​Benefit​HDHP
​Preventive prescription drugs generic retail (30/90 days)​$6/$18
Not subject to HDHP deductible
​Preventive prescription drugs generic mail order (90 days)​$15
Not subject to HDHP deductible
​Preventive prescription drugs formulary brand retail (30/90 days)​$30/$90
Not subject to HDHP deductible
​Preventive prescription drugs formulary brand mail order (90 days)​$75
Not subject to HDHP deductible
Formulary brand and ​generic retail (30/90 days) and mail (90 days)Member pays 100% up to deductible amount; after deductible, member pays 30% subject to $150 (30 day), $450 (90 day), or $375 (90 day mail) max
​Non-formulary brand retail and mail ​Not covered
​Prescription and medical out-of-pocket maximumPart of the total maximum out-of-pocket

Total maximum out-of-pocket

$5,000/member; $10,000/family**

*The medical out-of-pocket maximum is the most a PPO member will pay in a year in the form of coinsurance. It does not include copays, deductibles, or prescription drug costs.

**The total maximum out-of-pocket includes network deductibles and coinsurance; medical out-of-pocket maximum (PPO only); prescription drug out-of-pocket maximum (PPO only); copays (PPO and EPO); and prescription drug copays (non-formulary brand-name drugs excluded).