Welfare BenefitTabs™

  • Basic Description of BenefitMore Information

    The Plan pays for covered prescription drugs provided at either retail or mail order pharmacies. You must comply with the program rules regarding generic/name brand, preauthorization when required, and using the mail order pharmacy as indicated in order to obtain maximum benefits.

  • Pharmacy NetworkMore Information

    There are 4 places you can get your prescriptions:

    • Participating Retail Pharmacy: This is for prescriptions expected to run for 34 days or less. Use your ID card and pay only the copayment shown below.
    • Preferred Participating Mail Order Pharmacy: This is for maintenance prescriptions (those over 34 days). You can obtain a 90-day prescription by completing the prescription order form and mailing it in the pre-addressed envelopes. You will receive your medications via U.S. Mail.
    • Out-of-network Pharmacies: These are for participants who live in areas not served by a Participating Pharmacy. Reimbursement is at 50%.
    • Non-Participating Pharmacy: If you choose to purchase your drugs here, you will have to pay a 100% copayment

  • Generic / Name-brandMore Information

    If you or your physician requests that your prescription be filled with a brand name when a generic equivalent is available, you will be responsible for the difference in cost in addition to the brand-name copayment shown below.

  • Maintenance PrescriptionsMore Information

    For prescriptions which will be taken for longer than 34 days, it is required that you order these prescriptions through the mail order program. When the drug is initially prescribed for your use obtain 2 prescriptions from your doctor, one to be filled at the retail pharmacy (the first 30 days) and the second to be filled by mail order.

  • Your Copayment


    Participating Retail Pharmacy*
    (34-Day Supply)
    		 Preferred Participating Mail Order Pharmacy Non-Participating Pharmacy**
    Generic Drugs Participant copayment is 20% of the total cost of the Drug. Participant co-payment is the lesser of 20% of the cost of the drug or
    $20 for each prescription.    		 No Reimbursement
    Preferred Brand-name Drugs*

    Reimbursement Limitations apply,
    see below*

    		 Participant copayment is
    35% of the total cost of the
    Drug.    		 Participant co-payment is the lesser of 35%
    of the cost of the drug or
    $50 for each prescription.    		 No Reimbursement
    Non-Preferred
    Brand-name
    Drugs*Reimbursement Limitations apply,
    see below*    		 Participant copayment is
    50% of the total cost of the
    Drug.    		 Participant co-payment is the lesser of 50%
    of the cost of the drug or
    $100 for each prescription.    		 No Reimbursement
    Specialty Drugs (*)

    Must be filled by participating Specialty Drug mail order facility

    		 Not applicable. Participant co-payment is $100
    for each Specialty prescription for a 30-day supply. Noncompliance and failure to participate in the Patient Assistance Program, participant out-of-pocket is 100%.    		 No Reimbursement

  • To Find Participating Pharmacies


    Costco Pharmacy
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