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High Option
Consumer Driven Option
- Healthy Living
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High Option
Consumer Driven Option
All Members
- Change your address
- Order Claim Forms
- Form 1095-B
- Conversion Option
- Health Risk Assessments
- HIPAA Privacy Forms
- Notice of Privacy Practices
- Advance Directives
- Complaints and Grievances
- Member Rights and Responsibilities Statement
- Coordination of Benefits
- Surprise Billing Notice
- APW-ABA(external link)
- FSA Feds(external link)
- OPM.gov(external link)
- PostalEase(external link)
The High Option prescription drug plan includes access to nearly 64,000 pharmacies that belong to the Express Scripts network, along with home delivery options in all 50 states.
The convenient mail order program is ideal for members with long-term prescriptions. 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 (30-day supply) | 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 (90-day supply) | 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.