Drug Pricing Tiers
How Much Will I Pay?
How much you pay depends on:
- The tier your prescription drug is assigned to (check the PDL to find the tier for your drug).
- Where you get your prescription filled (retail or mail order).
See the following table for a summary of how much you'll pay for prescription drugs.
| Tier | Network Retail Pharmacy (up to a 90-day supply) | Wellpartner Mail-Order Pharmacy (up to a 90-day supply) | BioScrip Specialty Pharmacy for Specialty Drugs (up to a 30-day supply) |
|---|---|---|---|
| Tier 1 Generic drugs |
10% coinsurance or prescription cost-limit, whichever is less No deductible |
$10 copay1 No deductible |
$10 copay1 No deductible |
| Tier 2 Preferred brand-name drugs |
30% coinsurance or prescription cost-limit, whichever is less Deductible applies |
$50 copay1 Deductible applies |
$50 copay1 Deductible applies |
| Tier 3 Nonpreferred brand-name drugs |
50%2 Deductible applies |
$100 copay1,2 Deductible applies |
$100 copay1,2 Deductible applies |
1 If the cost of the drug is less than the mail-order copay, you pay only the actual drug cost.
2 Tier 3 drugs that have a generic equivalent are subject to an "ancillary charge."
What Is the "Ancillary Charge?"
If you get a Tier 3 drug that has a generic equivalent, UMP pays the same amount we would have paid if you had purchased the generic equivalent. You will pay the rest of the drug's cost. In most cases, this is significantly more expensive than the usual cost for a Tier 3 drug. Note: UMP does not make exceptions to this policy.
Prescription Cost-Limit for Tier 1 and Tier 2 Drugs Purchased at a Network Retail Pharmacy
The prescription cost-limit is the most you have to pay out-of-pocket for Tier 1 or Tier 2 drugs purchased at a network retail pharmacy using your UMP ID card. For:
- Up to a 30-day supply, your cost-limit is $75
- A 31- to 60-day supply, the limit is $150
- A 61- to 90-day supply, the limit is $225
There is no prescription cost-limit for Tier 3 drugs.
Annual Prescription Drug Deductible
There is no deductible for Tier 1 prescription drugs.
You must pay an annual prescription drug deductible to the pharmacy for purchases of Tier 2 and Tier 3 drugs before UMP covers these prescriptions. This deductible is $100 per person (a maximum of $300 for a family of three or more people covered under the same account). The deductible applies regardless of where you purchase your prescription. Once you meet the deductible, UMP pays benefits for the rest of the calendar year.
NOTE: What you pay (copays and coinsurance) for Tier 1 drugs does not count toward your prescription drug deductible.
