Prescriptions Your prescription drug benefit is included with your medical plan enrollment and is administered by MaxorPlus, a pharmacy benefits manager. When you enroll in medical coverage, you will receive a separate MaxorPlus ID card and information on locating a pharmacy near you. Most major pharmacy chains accept MaxorPlus. Present your MaxorPlus ID card when filling prescriptions. You can save money on medications you take on a long-term basis by using mail order with Maxor. With Maxor mail order, you are getting a 90 day supply for the cost of a 60 day supply.
MAXORPLUS – RETAIL (31 DAY SUPPLY)
Premium Option 2 (Surest)
Prescription Drugs
Base Plan (UMR)
Premium Option 1 (UMR)
Rx Max Out-of-Pocket Individual | Family
$1,000 | $2,000
$2,650 | $5,300
$1,150 | $2,300
Generic Drugs
$10 Copay $30 Copay
$10 Copay $30 Copay
$10 Copay $30 Copay
Preferred Brand Drugs
Non-Preferred Brand Drugs
$55 Copay
$55 Copay
$55 Copay
10% Coinsurance up to $100 Copay
10% Coinsurance up to $100 Copay
10% Coinsurance up to $100 Copay
Specialty Drugs
MAXORPLUS – MAIL ORDER (93 DAY SUPPLY)
Premium Option 2 (Surest)
Prescription Drugs
Base Plan (UMR)
Premium Option 1 (UMR)
Rx Max Out-of-Pocket Individual | Family
$1,000 | $2,000
$2,650 | $5,300
$1,150 | $2,300
Generic Drugs
$20 Copay $60 Copay
$20 Copay $60 Copay
$20 Copay $60 Copay
Preferred Brand Drugs
Non-Preferred Brand Drugs
$110 Copay
$110 Copay
$110 Copay
Specialty Drugs
N/A
N/A
N/A
MAXORPLUS
Pharmacy Network • Costco Pharmacy • CVS Pharmacy • Dillons Pharmacy • Hy-Vee Pharmacy • Medicine Shoppe
• Sam’s Club Pharmacy • Shopko Pharmacy
• Walgreens
• Wal-Mart Pharmacy
• Rite Aid
• HEB
• And many more!
• Price Chopper Pharmacy
Free Medications Formulary generic blood pressure, cholesterol, and select diabetic medications and supplies are free at any in-network pharmacy. Please talk to your doctor about prescribing a generic so you can save money. Pay the Difference Provision If you or your physician request a brand name drug when a generic equivalent exists and you choose to fill the brand drug, you will be responsible to pay the brand copay plus the difference in cost between the brand and generic.
8 - Employee Benefits Guide
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