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High Option
Consumer Driven Option
All Members
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The High Option has contracted with 70,432 retail pharmacies throughout the country. These pharmacies belong to the Express Scripts® Health Prescription Solutions network, and the pharmacies discount their charges and bill the Health Plan automatically for you.
The High Option Plan also offers a convenient mail order program for our members with long-term prescription needs. Both programs offer no deductible and low copayments.
Diabetes medications available through mail-order
- $0 copay for generic oral medication, formulary blood glucose test strips and lancets (used to reduce blood sugar)
- $25 copay for a 30-day supply of certain insulin and non-insulin drugs to treat diabetes
- $75 copay for a 90-day supply of certain insulin
- Standard dispensing limitations apply as outlined in the APWU Health Plan Federal Brochure on page 66
| In-network you pay | Out-of-network you pay | |
|---|---|---|
| Retail prescription drugs - non-specialty (30-day supply) |
$10 for Tier 1 drugs, 25% for Tier 2 drugs, maximum $200 per Rx, 45% for Tier 3 drugs, maximum $300 per Rx, (no deductible) |
50% ($10 minimum coinsurance), (no deductible) |
| Mail order prescription drugs - non-specialty (90-day supply) |
$20 for Tier 1 drugs, 25% for Tier 2 drugs, maximum $300 per Rx, 45% for Tier 3 drugs, maximum of $500 per Rx, (no deductible) |
N/A |
| Retail prescription drugs - specialty | 25% for Tier 1 drugs, maximum of $300 per Rx, 25% for Tier 2 drugs, maximum $600 per Rx, 45% for Tier 3 drugs, maximum $1,000 per Rx, (no deductible) |
50% ($10 minimum coinsurance), (no deductible) |
| Mail order prescription drugs - specialty | 25% for Tier 1 drugs, maximum $150 per Rx, 25% for Tier 2 drugs, maximum $300 per Rx, 45% for Tier 3 drugs, maximum $500 per Rx, (no deductible) |
N/A |
With both the mail order and the retail drug programs, there is no paperwork for the member to file. The pharmacy does the work for you.
