Prescription Benefits

All of our medical plans include prescription drug benefits. You can fill up to a 30-day supply at any retail pharmacy in the network. Just present your CVS Caremark ID card and make the required payment. Covered drugs are listed on the plan’s drug list, also known as the formulary. Please note that each plan has its own separate formulary.

Below is an overview of the prescription benefits.

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UNITED HEALTHCARE (UHC) Network Plan Tiered PPO Plan One Step PPO Plan*
Plan Benefits In-Network
Deductible (ded.) No deductible Medical deductible applies (excludes preventive care
medications)		 Medical deductible applies
Formulary Value Advanced Control Standard Control
Retail Prescriptions (30-day supply)
Generic / Preferred Brands / Non-preferred brands
 $12 / $60 $10 / $50 / $100 0% after ded.
Mail Order (90-day supply)
 $24 / $120 $20 / $100 / $200 0% after ded.
PrudentRx Specialty Medications $0 Copay** N/A N/A
Human Growth Hormone Medication Not Covered Covered 50% after deductible until out-of-pocket maximum is reached, then covered 100%. Prior authorization required. Covered 100% after deductible with prior authorization.
Fertility / Infertility Medication Not Covered Covered 50% after deductible. $10,000 lifetime Rx maximum. $10,000 lifetime Rx maximum.
*GT offers the One Step PPO medical plan for current enrollees only. This plan is closed to new members
** Must use PrudentRx specialty prescription drug card program.
Prior Authorization is required for Step Therapy drugs.

You pay a copay for each prescription you fill. You’re responsible for the difference in cost if you choose a brand name over a generic prescription. There’s no coverage for fertility/infertility or human growth hormone medication.

The Network Plan includes Prudent Rx a specialty program that optimize plan member savings. This specialty prescription drug card program optimizes savings for plan members. Highlights include:

  • $0 copay for certain specialty medications
  • Automatic opt-in
  • Requires registration for any available manufacturer’s copay assistance program for your Specialty Rx (Prudent Rx will assist)
  • Tiered and One Step not eligible due to IRS Regulations for HSA plans
  • If you voluntarily opt-out, you will pay a 30% copay for your Specialty Rx.
  • If your Specialty Rx does not have a manufacturer’s copay assistance program, you still have a $0 copay so long as you do not opt-out of the Prudent Rx program.

Prescription drugs are covered after you meet the medical plan’s annual deductible. There is no separate prescription drug deductible. However, you are responsible for copays and the difference in cost if you choose a brand name over a generic prescription. The plan's annual deductible is waived for preventive medications.

Once you meet your deductible, GT covers eligible prescription drugs 100%. All prescription medications, including preventive drugs, are subject to the deductible. If you choose to get a brand-name drug, you will be responsible for the difference in cost between that drug and the less-expensive generic alternative.

If you take a maintenance drug to treat an ongoing condition, such as high blood pressure, you may order a 90-day supply to be mailed directly to your home. Fill out the CVS Mail Order Form to get started. You may also fill 90-day supplies at CVS retail pharmacies, if preferred.

The GoodRx / Caremark Cost Saver program allows UHC members access to lower costs for many common generic medications covered under the plan. The program, through GoodRx, automatically provides the lowest price at the point of sale. A price comparison is conducted automatically, eliminating the need to shop around and any member out-of-pocket cost will be applied towards the plan out-of-pocket maximum.

* Not available in Florida.

GT medical plans include drug management programs to ensure you receive, safe, cost-effective medications. You and your health care provider may be asked to try a more cost-effective, therapeutically appropriate medication before progressing to a more costly option. Additionally, your provider may be asked for more information before certain drugs are approved.