Are prescriptions Eligible for Sharing?

Prescription medications (Rx) related to a new diagnosis are Eligible for Sharing with limitations.

Prescription medication expenses for prescribed drugs that may be dispensed, injected, or administered may be credited toward the PRA if they are not considered treatment for a pre-existing condition. After the member’s PRA has been met, eligible prescriptions will be shared as follows:

•    After the first $25 on generic drug prescription

•    After the first $50 on brand name prescription when a generic is unavailable

•    Prescription medications must be purchased using the member ID card (see Rx information on the card)

•    Members pay 100% of the prescription amount at the pharmacy

•    Prescription drugs that may be dispensed, injected or administered

•    Psychotropic medication and birth control expenses are not eligible for sharing

The shareable amount is limited to $1200 per member per membership year after the PRA has been met.

Exceptions may be made in the case of medications for cancer and transplant recipients.

Note: Members 65 and older must have Medicare Part D for prescription costs to be eligible for sharing. All sharing will be secondary to Medicare.