Prescription Drugs
The member pays the pharmacy dispensing fee plus the pharmacy markup for eligible drugs . The plan pays for 100% of the ingredient cost of eligible drugs, subject to policy maximums as follows:
- Coverage is limited to drugs which legally require a written prescription in order to be dispensed including seras, injectables and oral contraceptives. Prescription by law smoking cessation drugs are subject to a maximum lifetime payment of $500 per insured member .
- Drugs used in the treatment of sexual dysfunction are subject to a maximum of $500 per person per calendar year . Fertility drugs are subject to a lifetime maximum of $15,000 per insured member .
- Whenever an interchangeable generic product is available, but not dispensed, eligible expenses shall be limited to the cost of the lowest priced generic substitute.
- Life sustaining drugs of a non-prescription nature when prescribed by a physician or dentist, and dispensed by a pharmacist, physician or dentist may be eligible for coverage.
- Drugs and medically required supplies of a non-prescription nature required as a result of a colostomy and/or for the treatment of cystic fibrosis, diabetes and Parkinsonism may be eligible for coverage.