How Much Will I Pay for Prescription Drugs?
How much you pay depends on the tier your prescription drug is assigned to (check the PDL to find the tier for your drug).
You may get up to a 90-day supply for most drugs, except for specialty drugs.
| Tier | All Network Pharmacies |
The Most You'll Pay Per 30-Day Supply |
|---|---|---|
| Value Tier | 5% coinsurance |
$10 |
| Tier 1 Select Generic Drugs |
10% coinsurance No deductible |
$25 |
| Tier 2 Preferred Drugs |
30% coinsurance Deductible applies |
$75 |
| Tier 3* Nonpreferred Drugs |
50% coinsurance Deductible applies |
Specialty drugs** only: $150 |
* Brand-name drugs that have a generic equivalent are subject to an ancillary charge. Ancillary charges do not count toward your prescription drug deductible.
**Specialty drugs must be purchased through the plan's network specialty pharmacy, Diplomat. See "Prescription Cost-Limit for Specialty Drugs" for more information on how this works. You may pay more than $150 for Tier 3 specialty drugs that have a generic equivalent and are subject to an ancillary charge.
What Is the Ancillary Charge?
If you get a Tier 3 drug that has a generic equivalent, the plan pays the same amount it would have paid if you had purchased the generic equivalent. You 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.
Prescription Drug Deductible
There is no deductible for Value Tier or Tier 1 prescription drugs.
You must pay a prescription drug deductible to the pharmacy for purchases of Tier 2 and Tier 3 drugs before UMP Classic covers these prescriptions. This deductible is $100 per person (a maximum of $300 for a family of three or more people). The deductible applies regardless of where you purchase your prescription. Once you meet the deductible, UMP Classic pays benefits for the rest of the calendar year.
NOTE: What you pay for Value Tier and Tier 1 drugs does not count toward your prescription drug deductible.
