Results for Prescription Drugs
Prescription Drugs with the HRA Option
With prescription drug coverage in the HRA option, you don’t have to meet your medical deductible before you start enjoying prescription drug benefits. This prescription drug coverage also has an out-of-pocket maximum, which limits how much you have to pay for prescription drugs during the year.
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| HRA Retail (up to 30-day supply) | HRA Mail Order (up to 90-day supply) | |
|---|---|---|
| Deductible | None | None |
| What The Plan Pays: Value-Based Generic Copay | 100% after $5 copay | 100% after $10 copay |
| What The Plan Pays: Generic Copay | 100% after $10 copay | 100% after $20 copay |
| What The Plan Pays: Value-Based Preferred Brand Name Coinsurance | 90% ($50 max/Rx) | 90% ($100 max/Rx) |
| What The Plan Pays: Preferred Brand Name Coinsurance | 80% ($100 max/Rx) | 80% ($200 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: Non-Preferred Brand Name Coinsurance | 60% ($120 max/Rx) | 60% ($240 max/Rx) |
| HRA Rx Out-of-Pocket Maximum | You You + one You + family | You You + one You + family |
Reasonable and Customary Charges: The plan pays up to reasonable and customary (R&C) charges for out of network care. You are responsible for any cost difference if your expenses are more than the R&C limits.
Value-Based Prescription Discount
If you are enrolled in the HRA option and take medication for high blood pressure, high cholesterol or diabetes (medications only), you will pay 50% less for your value-based prescriptions. These conditions were selected for special value-based pricing because improving them will have the largest impact on the overall health of Rockwell Automation employees.
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.
Brand Penalty
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 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 out-of-pocket maximum.
Using the Money in Your HRA
You can use the money in your Health Reimbursement Account (HRA) to pay for eligible medical expenses for you and your dependents covered by the plan. Eligible expenses include prescription drugs, office visits and hospital expenses. If you do not use all the money in your HRA during the year, the funds roll over to the next plan year if you stay in the HRA option.
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.
Compound Drugs
Compound drug prescriptions that cost more than $300 require prior authorization.
