Prescription Coverage
What you need to know
With this plan, there is no deductible for prescription drugs. Cost sharing begins immediately and applies until you meet the separate prescription drug out-of-pocket limit for this plan.
Filling Your Prescriptions
You can get prescriptions at a network pharmacy; for medications you take regularly, you also have the option for mail order from Optum Rx® Pharmacy or Kaiser mail order if you’re a Kaiser member.
Find a pharmacy:
- BCBSNM and UnitedHealthcare participants, click here
- Kaiser participants, click here (click on search doctors, then select pharmacies)
What You Pay
| Prescription Drug Out-of-Pocket Limit* | A separate out-of-pocket limit applies $1,500 per individual, up to $5,950 combined for all family members |
| Retail Pharmacy or Optum Rx specialty mail order | |
|---|---|
| Generic / specialty generic | $0 for many preventive medications Other generic medications: 20% ($5 min / $10 max) |
| Formulary brand | 30% ($30 min / $45 max) |
| Non-Formulary brand | 40% ($75 min / $112.50 max) |
| Specialty Brand | 40% ($75min / $112.50 max) |
| Optum Rx Mail Order or Optum Rx Retail (90-day supply), Kaiser Mail Order (100-day supply) | |
| Generic / specialty generic | $0 for many preventive medications Other generic medications: 20% ($12.50 min / $25 max) |
| Formulary brand | 30% ($75 min / $112.50 max) |
| Non-Formulary brand | 40% ($125 min / $187.50 max) |
| Specialty Brand | 30% ($150 min / $225 max) |
* The cost of out-of-network prescription drugs purchased outside of the program is covered at 50% and does not apply toward the out-of-pocket limit.
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.