Prescription Drugs

Understanding your prescription drug plan is the first step to making the most of your Rx benefits.

• In-Network Coverage Only
  For the best price, be sure to use an in-network pharmacy. You will pay the full cost if you fill your medications at an out-of-network pharmacy.
• Annual Rx Deductible
  Plan members have a $250 per person prescription drug deductible. This means you will pay the full cost for prescriptions until you reach this amount; then, the plan will begin to pay a portion of the medication cost.
• Costs After Your Rx Deductible Is Met
  Your out-of-pocket costs will depend on the tier of medication as follows:
  • Generic prescriptions are just as effective as preferred brand name drugs at a fraction of the cost. You are required to try generic first before the plan will pay for a preferred brand name medication.
  • Preferred Brand Name prescriptions offer great value for a slightly higher cost than generic. These drugs are included in the OptumRx app formulary, which is a list of the preferred medications.
  • Non-Preferred Brand Name prescriptions cost the most out-of-pocket. These are medications not listed on the formulary.
• Out-of-Pocket Maximum
  Your prescription drug expenses count toward your medical out-of-pocket maximum. The out-of-pocket maximum is the most that you’ll have to pay for your medications in the plan year.

Plan Feature	Retail Pharmacy * (31-day supply)	Home Delivery * (90-day supply)
Deductible	$250/person
What You Pay After the Deductible
Generic	10% ($10 min, $20 max)	10% ($25 min, $50 max)
Preferred Brand Name (Formulary)	30% ($50 min, $100 max)	30% ($125 min, $250 max)
Non-Preferred Brand Name (Non-Formulary)	50% ($75 min, $150 max)	50% ($187.50 min, $375 max)

VIVIO will manage all prescriptions for specialty medications for you and your covered family members.

Specialty medications are commonly used to treat chronic, complex, or rare conditions such as rheumatoid arthritis, psoriasis, irritable bowel disease, multiple sclerosis, cancer, cystic fibrosis, and other conditions.

If you have a question or if you’d like to know if a specialty drug is managed by VIVIO, please contact the VIVIO Concierge Team at 800-470-4034 or email concierge@viviohealth.com.

Lennox medical plan members can access 24/7 nurse assistance through Quantum Health’s Chronic Condition Support Program. If you suffer from one of the following chronic conditions, you’ll receive personalized treatment management services: asthma, diabetes, chronic obstructive pulmonary disease (COPD), coronary artery disease (CAD), or congestive heart failure (CHF).

If you’ve been diagnosed with one of the chronic conditions listed above you may qualify for Quantum Health’s $0 Copay Prescription Program, which covers certain approved medications at no cost (no copay required). NOTE: You must complete 100% of the required care path activities to qualify for this benefit.