How pharmacy coverage works
Both health plans offer prescription medication coverage. How you pay and how much you pay for your prescriptions depends on several things:
- The medical plan you choose will determine if you pay a set copay or deductible/coinsurance:
The medical plan you choose will impact how much you pay for your medications. It is important to review the medications you are currently taking to see which plan best fits your needs.
- Signature Plan: If you choose the Signature Plan, you will primarily pay set copays of $5 to $200 depending on the medication you are prescribed, the pharmacy you choose and how many days’ supply you receive.
- HSA Advantage Plan: If you choose the HSA Advantage Plan, you will primarily pay coinsurance, or a percentage of the cost, for your medications. Here’s how it works: you pay the full cost of prescriptions until you reach your annual deductible. After that, you pay coinsurance of 10-30% until you reach your out-of-pocket maximum.
Learn more about deductibles, copays, coinsurance and out-of-pocket maximums in our guide to understanding how you and the health system share the cost for your healthcare expenses.
- The tier of the medication on the health plan’s prescription drug formulary:
The formulary and coverage of medications are the same in both the HSA Advantage and Signature plans. However, what you pay is different. As noted above, for the HSA Advantage Plan, you will pay the deductible and then once it is met you will pay 10% for medications at the health system pharmacy and 30% at an in-network pharmacy. Search for in-network pharmacies on the Navitus pharmacy network list, the Navitus member portal or the Navitus mobile app. For the Signature Plan, use the tiers listed on the formulary to know what your copay is for each listed medication. You will find a list of the medications covered on the prescription drug formulary provided by Navitus. It’s a good idea to make a list of your drugs and compare it to the formulary when choosing your medical plan. Then, consider how the copay or deductible plus coinsurance models described above will impact your share of the cost. Learn more about how the formulary works and impacts the amount you pay for your medication. - The type of medication you’re prescribed:
Prescriptions fall into three general medication types that determine where you can fill the prescription and how many days’ supply you can receive.
- Acute medications are prescribed to treat short-term symptoms for a specified period of time (antibiotics, antivirals, steroids, etc.). Learn more about acute medication coverage.
- Maintenance medications are prescribed for long-term, regular use to treat a chronic health condition (asthma, diabetes, high blood pressure, etc.). Learn more about maintenance medication coverage.
- Specialty medications are prescribed to treat complex health conditions. Learn more about specialty medication coverage.
- Where you fill your prescriptions:
For the best service and most cost-effective options for your medications, use the health system pharmacy, which offers a free delivery service.
