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Benefits

Prescription Benefit Copays

What You Need to Know: 

The prescription copays vary for current employees, retirees over 65 (Medicare Carveout), and retirees under age 65. See below for charts and comparison.

Current Employees & Pre-Medicare Eligible Retirees (under 65)

The copayments or coinsurance for each type of 90-day prescription available at UK Retail Pharmacies or Express Scripts Mail Service Pharmacy are:

30-Day Supply Minimum Out-Of-Pocket Maximum Out-Of-Pocket
Generic 20% or minimum of $8
 
maximum of $50 per prescription
Formulary Brand 40% or minimum of $20 maximum of $60 per prescription
Non-Formulary Brand 50% or minimum of $40 no maximum

The copayments or coinsurance for each type of 90-day prescription available at UK Retail Pharmacies or Express Scripts Mail Service Pharmacy are:

90-Day Supply Minimum Out-Of-Pocket Maximum Out-Of-Pocket
Generic 10% or minimum of $24 maximum of $100 per prescription
Formulary Brand 30% or minimum of $60 maximum of $120 per prescription
Non-Formulary Brand 40% or minimum of $120 no maximum

View the UK High Performance Formulary (PDF).

Medicare Eligible (Over 65) Prescription Copays

Prescription Drug Benefit Coverage Levels

Drugs in our formulary are organized into different drug tiers or groups of drug types. Your coinsurance depends upon the tier in which your drug is placed. Please look at the latest Medicare Formulary to determine the "tier" placement of your medication.

Prescription Coinsurance Copays (Amount Paid by Retiree)

Medicare Part D Prescription Drug PLan Retail Pharmacy (per 30 -day supply) Express Scripts Mail Order Pharmacy
Generic Drugs 20% coinsurance, $50 maximum 10% coinsurance, $100 maximum
Preferred Brand Drug 40% Coinsurance, $20 min, $60 max 30% Coinsurance, $60 min, $120 max
Non-Preferred Brand Drug 50% Coinsurance, $40 min, $100 max 40% Coinsurance, $120 min, $200 max
Specialty Drug As above, limit to 30 day supply  As above, limit to 30 day supply 

Yearly Deductible for Drug Coverage

This is the amount you pay for your prescriptions before your plan starts to share in the costs.  There is NO annual deductible for your UK Medicare Prescription Drug Benefit.

Coverage "Gap"

Please note: Your coverage is continuous. Many Medicare drug plans may have a "coverage gap," which is sometimes called the "donut hole." This means that after you have spent a certain amount of money for covered drugs, you have to pay all costs for your drugs while you are in this "gap." Unlike many other Medicare prescription drug plans, the UK Medicare Part D plan provides continuous coverage through the gap. 

Catastrophic Coverage

Once you have reached the plan's true out-of-pocket limit (also known as  TrOOP), you will have "catastrophic coverage."  Once you have reached this point (2013), you will pay the greater of 5% or $2.65 for generic drugs. For all other drugs, you will pay the greater of 5% or $6.60. 

Other Links

Current Medicare Formulary

UK Medicare Part D (UK Medicare Carveout Prescription Drug Benefit) Evidence of Coverage Document