Pharmacy Resource Guide – Section 2

Both medical plans – the HSA Advantage Plan and Signature Plan – include prescription medication coverage. How you pay for prescriptions is very different depending on which plan you choose.

Here are important things every plan member should know. Specifics are listed in the chart below.

• With the HSA Advantage Plan, you pay 100% of the cost for all prescriptions until your deductible is met (the deductible resets every year on Jan. 1). Note: For the preventive drugs, you pay the same copay as the Signature Plan, which is typically lower than the deductible plus coinsurance. Both plans charge copays for drugs on the preventive medication list, used to treat chronic conditions such as diabetes. For HSA Advantage Plan members, the copay is typically lower than the deductible plus coinsurance.
  • After that, you pay a percentage of the total cost (10% at the health system pharmacy) until you reach the out-of-pocket maximum.
  • Consider your medication costs and the amount you’ll need to pay early in the year until you meet your deductible.
• With the Signature Plan, you pay a set copay amount, regardless of whether the annual deductible has been met.
• Both plans cover the same medications, which are listed in the prescription drug formulary. The higher the tier the drug falls into on the formulary, the higher the cost to you.
• There are three categories of medications (acute, maintenance and specialty) and there are specific directions for where and how to fill prescriptions for each type. If you don’t follow these requirements, coverage will be denied.
• With both plans, using manufacturer assistance (copay cards) may lower your costs at the pharmacy. Note: The amount paid by the manufacturer will not apply to your deductible or out-of-pocket maximum.