Prescription Benefits
When you enroll in the Oxford Health Plans, you are automatically provided with prescription benefits. Whether you obtain your prescription medications at a participating retail pharmacy or through the mail order program, you will be responsible for satisfying a copay. You may be able to control your copay amount based on the types of medication you select (e.g. Tier 1 vs. Tier 2 vs. Tier 3). The specific copay amounts that you are responsible for are indicated in the table below. You are encouraged to contact your physician about the availability of Tier 1 (lowest cost) medications for yourcondition.
About Patient Safety Oxford is required to follow FDA and manufacturer
PrescriptionBenefits
Benefit Description
CoreOxford EPO 20/40 & Buy-UpOxford PPO20/40
OxfordHDHP$1,500/90% w/HSA
dispensing rules and regulations in order to ensure patient safety. Please review the Prescription Drug List for dosage/ quantity limits and for prescriptions that require precertification or priorapproval. A copy ofthe Prescription Drug List can be found online at: www.oxhp.com. The Ancillary Charge Program If you choosea lower-cost generic medication – you will pay only your cost share (e.g.,copayment, coinsurance) with no additional charge. If you choose ahigher- cost brand-name medication when a chemically equivalent prescription drug is available on a lower tier (e.g., generic) – you willpay your cost share, plus the difference in price between the brand-
Prescription Deductible
$100 (waived for Tier 1 medications)
Medicaldeductibleappliesbeforecopays
Retail Pharmacy Program (e.g.CVS, Walgreens, etc.) (Up to a 30-day supply)
$5copay $35copay $70copay
$10copay $40copay $80copay
Tier1 Tier2 Tier3
Mail Order Program (Uptoa90- day supply)
$12.50copay $87.50copay $175copay
$25copay $100copay $200copay
Tier1 Tier2 Tier3
PRESCRIPTION TIERS Oxford has a specific method of assigning tier levels to prescription medications. Assignment of tier level for a prescription medication is based on wholesale costs and other factors. Prescription medications are broken out into the following tier levels:
PrimarilyGeneric- These medications are offered at the lowest copay amount and provide the highest overall value per dollar. Primarily Brand - These medications are offered at the next lowest copay amount and are listed on Oxford’s applicable Prescription Drug List. Primarily Non-Preferred - These medications are offered at the highest copayamount.
Tier1:
Tier2:
Tier3:
If your physician prescribes a brand name medication and notes on the prescription, "dispense as written" (DAW), then you will receive this specific drug instead of a lower cost alternative. However, you will pay a higher copayment. Please refer to The Ancillary Charge Program to the left for details on utilizing generic drugs. GenericMedications – Safe, Effective,Affordable: Genericmedicationsarecertifiedbythefederal Food and Drug Administration (FDA) to meet the same strict standards for safety, strength, and effectiveness as their brand name counterparts, yet can be significantly less expensive. Although the active ingredients of generic drugs may be different, the drug may be used to treat the same condition and provides the same or a similar therapeutic effect. The majority of generic medications are manufactured by the same companies that manufacture the brand-name drugs. To get the most value from your prescription benefits, ask your doctor to prescribe generic medications, whenever possible. Mail Order Program: The mail order program is a convenient, cost-saving alternative to using your local pharmacy. Using this program, you can receive a three-month supply of a maintenance medication for 2.5 times the retail (one month) copay. Over a year, the savings could be considerable. Refer to the example at right for more information. Note: Under "Select Designated Pharmacy Program", you may receive notifications regarding tier level medication changes, or medications that can only be filled via mail order .
name andthe generic drug.
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