Prescription Drug

Prescription Drug Coverage Highlights

  • Six plans available with copay levels to meet most budgets.
  • For all non-High Deductible Health Plans (HDHPs), coverage is offered as a four tier prescription drug plan:
    • Generic (Tier1)
    • Brand Formulary (Tier 2)
    • Brand Non Formulary (Tier 3)
    • Specialty Drugs (Tier 4)
  • For HDHPs, prescription coverage is embedded and applicable cost-sharing applies.
  • More than 69,000 chain and independent pharmacies across the U.S. are in network, and no major chains are excluded.
  • A mail-order / home delivery program is available for maintenance drugs at a steep discount.
    USHL professionals address member and pharmacist questions, and Magellan Rx Management representatives are available to assist with questions such as the tier level of a specified drug.
  • Members have access to an online prescription benefit manager for drug lookups, prior-authorization guidelines, and a tool to find the nearest pharmacy offering a specified drug at the lowest cost.

This information summary is provided for marketing purposes only and does not represent a guarantee of coverage. For a complete list of policy provisions and exclusions, please refer to the USHL Medical Policy or Prescription Drug Rider.

USE OUR ONLINE FORMULARY TOOL

SEE OUR SPECIALTY DRUG FORMULARY

SEE OUR IN-NETWORK PHARMACIES

Plan NameHighlightsCopaysSpecialty Drug Coverage
Plan 1
  • Enjoy 100% coverage with in-network providers, but 0% coverage out-of-network.
  • Home delivery options may be available, depending on type of drug.
  • Some drugs may require prior authorization.
Tier 1 / Generic Drugs: $15
Tier 2 / Brand Formulary: $30
Tier 3 / Non-Brand Formulary: $50
Tier 4 / Specialty Drugs: Covered at 25% at in-network pharmacies
Plan 2
  • Enjoy 100% coverage with in-network providers, but 0% coverage out-of-network.
  • Home delivery options may be available, depending on type of drug.
  • Some drugs may require prior authorization.
Tier 1 / Generic Drugs: $15
Tier 2 / Brand Formulary: $35
Tier 3 / Non-Brand Formulary: $60
Tier 4 / Specialty Drugs: Covered at 25% at in-network pharmacies
Plan 3
  • Enjoy 100% coverage with in-network providers, but 0% coverage out-of-network.
  • Home delivery options may be available, depending on type of drug.
  • Some drugs may require prior authorization.
Tier 1 / Generic Drugs: $15
Tier 2 / Brand Formulary: $50
Tier 3 / Non-Brand Formulary: $80
Tier 4 / Specialty Drugs: Covered at 25% at in-network pharmacies
Plan 4
  • Enjoy 100% coverage with in-network providers, but 0% coverage out-of-network.
  • Home delivery options may be available, depending on type of drug.
  • Some drugs may require prior authorization.
Tier 1 / Generic Drugs: $20
Tier 2 / Brand Formulary: $40
Tier 3 / Non-Brand Formulary: $60
Tier 4 / Specialty Drugs: Covered at 25% at in-network pharmacies
Plan 5
  • Enjoy 100% coverage with in-network providers, but 0% coverage out-of-network.
  • Home delivery options may be available, depending on type of drug.
  • Some drugs may require prior authorization.
Tier 1 / Generic Drugs: $25
Tier 2 / Brand Formulary: $50
Tier 3 / Non-Brand Formulary: $70
Tier 4 / Specialty Drugs: Covered at 25% at in-network pharmacies
Plan 6
  • Enjoy 100% coverage with in-network providers, but 0% coverage out-of-network.
  • Home delivery options may be available, depending on type of drug.
  • Some drugs may require prior authorization.
Tier 1 / Generic Drugs: $30
Tier 2 / Brand Formulary: $60
Tier 3 / Non-Brand Formulary: $85
Tier 4 / Specialty Drugs: Covered at 35% at in-network pharmacies

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