Your prescription drug coverage will be provided through your pharmacy benefit manager. The pharmacy benefit manager could be a separate prescription drug company. Employees who enroll under Aetna, Highmark Blue Cross Blue Shield, Cigna, or UnitedHealthcare will have their pharmacy benefits managed by OptumRx. All other carriers will manage their own prescription drug coverage.

That means your prescription drug coverage depends on the medical coverage level you choose and your medical insurance carrier.

Your Coverage Level Matters

You pay nothing for preventive drugs, as determined by your pharmacy benefit manager. You need a doctor’s prescription, and you must use an in-network retail pharmacy or mail-order service.

Bronze, Bronze Plus, or Silver
You pay the full cost for prescription drugs until you reach the annual medical deductible. Then you pay coinsurance. Once you reach the out-of-pocket maximum, you pay nothing.

Gold or Platinum
You pay a copay for all prescription drugs. Once you reach the out-of-pocket maximum, you pay nothing.

Your specific prescription coverage is based on the medical coverage level you select. Get the details.

Your Carrier Matters

Each pharmacy benefit manager has its own rules about how prescription drugs are covered. So you need to do your homework to find out how your medications will be covered—before choosing an insurance carrier.

Get a list of prescription drug questions to ask.