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High Option pharmacy program

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
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.