Results for Prescription Drugs
Preferred vs. Non-Preferred Brand Name Drugs
Preferred brand name (or formulary) drugs have been determined to provide effective treatment when used as intended and typically cost less then non-preferred brand name drugs. Non-preferred brand name (or non-formulary) drugs tend to be expensive and often have a less expensive generic or preferred brand name alternative available.
|HRA Retail (up to 30-day supply)||HRA Mail Order (up to 90-day supply)|
|What The Plan Pays: Value-Based Preferred Brand Name Coinsurance|
90% ($50 max/Rx)
90% ($100 max/Rx)
|What The Plan Pays: Value-Based Non-Preferred Brand Name Coinsurance|
80% ($60 max/Rx)
80% ($120 max/Rx)
|What The Plan Pays: Preferred Brand Name Coinsurance|
80% ($100 max/Rx)
80% ($200 max/Rx)
|What The Plan Pays: Non-Preferred Brand Name Coinsurance|
60% ($120 max/Rx)
60% ($240 max/Rx)
Reasonable and Customary Charges: Up to reasonable and customary (R&C) charges for out of network care. You are responsible for any cost difference if the dental expenses are more than MetLife’s allowed R&C charges.
Coverage is different in the HSA option
If you are enrolled in the HSA option, your prescription drug coverage is different. Visit the HSA option page for prescription drug information that applies to you.
A brand penalty is what you pay if you choose to fill your prescription with the brand name drug instead of the available direct generic version. The penalty amount is the difference between what the brand name drug costs and what the generic drug costs.
If you are prescribed a drug that does not have a generic version and is not on the indirect generic list, you will not be charged the brand penalty for filling that brand name drug.
Brand Penalty Does Not Count Toward Deductible or Out-of-Pocket Maximum
The brand penalty, or cost you pay for filling the brand name drug versus the generic drug, does not count toward your deductible or out-of-pocket maximum.
Compound drug prescriptions that cost more than $300 require prior authorization.
Save Money with Generics
Generic drugs may look a little different than the brand name prescriptions, but they are just as effective, and they consist of identical ingredients in the same formulation. Plus, every ingredient that goes into a generic drug must be approved by the FDA.
If your pharmacy fills a brand name medication for any reason and a generic is available, you will pay the difference between the brand name and the generic, plus the brand coinsurance.
Save money and go generic the next time you’re at the pharmacy.