Prescription Coverage
What you need to know
The Health Savings Plan comes with comprehensive prescription drug coverage, including an enhanced prescription drug benefit.
Filling Your Prescriptions
You can fill prescriptions at a network pharmacy; for medications you take regularly, you must have the option for mail order from Optum Rx® Pharmacy.
Find a pharmacy:
- BCBSNM and UnitedHealthcare participants, click here
What You Pay
You’ll pay nothing for generic preventive medications included on the Optum Rx Preventative Generic Drug List.
For all other prescription drugs, you’ll pay 100% of the cost— but only until you meet your annual combined medical and prescription drug deductible. At that point, the plan will begin to share costs with you, based on the type of medication prescribed (generic, formulary brand, non-formulary brand, or specialty), until you meet the out-of-pocket limit for the year. When pricing medications on the Optum Rx® website for the Health Savings Plan, be sure to choose the tab marked “Deductible is not met” to see the full cost of the medication before cost sharing.
Your medical and prescription drug costs combine and accumulate together toward one out-of-pocket limit. In addition, your family members’ expenses accumulate together to meet the Health Savings Plan’s overall family deductible and out-of-pocket limit amounts. You pay the full costs before plan cost sharing begins for any one family member.
Here’s what that looks like:
| Prescription Drug Deductible | Combined with medical deductible |
| Prescription Drug Out-of-Pocket Limit* | Combined with medical out-of-pocket limit |
| Retail Pharmacy In-Network or Optum Rx Mail Order (up to 30-day supply) | |
|---|---|
| Generic / specialty generic | $0 for drugs on an expanded list of preventive medications All other generic drugs: 20% after deductible ($5 min / $10 max) |
| Formulary brand | 30% after deductible ($30 min / $45 max) |
| Non-Formulary brand | 40% after deductible ($75 min / $112.50 max) |
| Specialty Brand | 30% after deductible ($75 min / $112.50 max) |
| Optum Rx Mail Order or Retail Pharmacy 90-day supply | |
| Generic / specialty generic | $0 for drugs on an expanded list of preventive medications All other generic drugs: 20% after deductible ($12.50 min / $25 max) |
| Formulary brand | 30% after deductible ($75 min / $112.50 max) |
| Non-Formulary brand | 40% after deductible ($125 min / $187.50 max) |
| Specialty Brand | 30% after deductible ($150 min / $225 max) |
Contacts and Resources
Go to the Get to Know Our Benefit Providers page for details.
Completing an annual health assessment enables you to evaluate your current health status, track progress and identify any potential setbacks.
By pairing the health assessment with health coaching, you create a powerful strategy for heightened awareness and actionable steps that lead to improved well-being.