Download Walgreens Health Initiatives (WHI)

Walgreens Health Initiatives (WHI)
PRESCRIPTION DRUG BENEFITS
Prescription Drug Card
Network Pharmacy Benefits
Retail
30-Day Supply
Walgreens Retail Stores or
Mail Order
90-102 Day Supply
Generic (Tier 1)
$7 Co-pay
$14 Co-pay
Preferred Drugs (Tier 2)
$20 Co-pay or 10%
whichever is greater
$40 Co-pay or 10%
whichever is greater
Non-Preferred Drugs (Tier 3)
$40 or 10% whichever is
greater
$80 or 10% whichever is
greater
PRESCRIPTION DRUG CARD PROGRAM
Eligible drugs and medicines prescribed in writing by a Physician and dispensed by a licensed
pharmacist, up to a thirty (30) day supply at retail locations (90-102 day supply at Walgreens
retail stores or mail order) which are deemed necessary for treatment of an Illness or Injury,
including, but not limited to, insulin, diabetic supplies, smoking deterrents, and nonimplantable
contraceptives regardless of intended use.
Expenses for injectables not covered under the Prescription Drug Card program will be payable
under this Plan subject to any applicable PPO Deductibles and Co-insurance.
NOTE: Coverage, limitations, and exclusions for prescription drugs will be determined through
the Prescription Drug Card program elected by the Employer and will not be subject to any
limitations and exclusions under the major medical plan. The Prescription Drug Card program is
a separate benefit from the major medical plan.
1st Tier – Generic – Most generic drugs are in the 1st tier. These drugs generally the least
expensive are the most cost –effective for both you and your plan sponsor.
2nd Tier – Preferred Drugs – A 2nd tier drug is a brand-name drug that either does not have a
generic equivalent or may be a less-expensive, but equally effective, alternative to it’s 3rd-tier
counterpart. These drugs also are referred to as preferred-brand drugs.
3rd Tier – Non-Preferred Drugs – A 3rd-tier drug is a brand-name drug that may have either a
generic or 2nd –tier alternative available. These drugs generally are the most expensive drugs
for both you and your plan sponsor and are referred to as non-preferred brands.
Z:\BENEFITS\HEALTHCARE PLAN\Website Information\whi copays.doc