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.

ONLINE FORMULARY TOOL SPECIALTY DRUG FORMULARY IN-NETWORK PHARMACIES PRESCRIPTION DRUG COVERAGE

Coverage Options

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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