The deductible does not apply to prescriptions.
Non-Specialty Prescription Drug Benefits¹ | Premier & Mail-Order Pharmacies | Non-Premier Pharmacies (CVS/Walgreens) | All Other Pharmacies |
Tier 1 — Generic |
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• 1-34 day supply | $15 copay³ | $15 Copay³ (+$25 Choice Fee) | $15 Copay³ (+$10 Choice Fee) |
• 35-90 day supply | $40 copay³ | $40 Copay³ (+$25 Choice Fee) | $40 Copay³ (+$10 Choice Fee) |
Tier 2 — Non-Preferred Formulary Brand |
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• 1-34 day supply | 25% of the cost, up to $100 | 25% of the cost, up to $100 (+$32 Choice Fee) | 25% of the cost, up to $100 (+$10 Choice Fee) |
• 35-90 day supply | 25% of the cost, up to $300 | 25% of the cost, up to $300 (+$32 Choice Fee) | 25% of the cost, up to $300 (+$10 Choice Fee) |
Tier 3 — Non-Preferred Formulary Brand | 40% of the cost | 40% of the cost (+$36 Choice Fee) | 40% of the cost (+$10 Choice Fee) |
Specialty Prescription Drug Benefits¹ | Mail-Order Pharmacies | Non-Premier Pharmacies (CVS/Walgreens) | All Other Pharmacies |
Tier 1 — Generic | 25% of the cost, up to $500 | Unlikely to be available. If available, fees will apply. | Unlikely to be available. If available, fees will apply. |
Tier 2 — Preferred Formulary Brand | 25% of the cost, up to $500 |
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| Tier 3 — Non-Preferred Brand | 40% of the cost |
(1) Select products are eligible for a coinsurance assistance program. There is no copay for these products, and they do not accumulate toward the out-of-pocket maximum. For more information contact THT at 702-794-0272, Option 1. (2) Prescriptions filled at pharmacies other than THT’s Premier Pharmacies will incur additional Choice Fees in addition to applicable copays. (3) If the generic cost of the medication is less than the copay, the individual will be responsible for that lesser amount. (4) For more information about this service, please contact LucyRX at 844-622-1797.