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Short Term Medical plan pharmacy and drug coverage information

Short Term Medical plans are underwritten by Golden Rule Insurance Company.

Is my medication covered?

The cost of covered prescriptions will vary depending on the plan you have. You may pay a copay, or your medication may be subject to deductible and coinsurance. The Drug Pricing tool can help you compare prices for specific drugs at pharmacies near you.

• Prescription Drug List (PDL) - Effective July 1, 2019
• Prescription Drug List (PDL) - Effective January 1, 2020
• Formulary Lookup Tool
• Generic Only PDL¹

¹- Applies to the Generic Only $20 Copay option available on Short Term Medical Plus, Short Term Medical Plus Elite, Short Term Medical Copay, and Short Term Medical Copay Value plans.

Where can I get my prescription filled?

The pharmacy network includes large national chains and many local, community pharmacies.

• Find a network pharmacy

Note: Mail-order refills and 90-day supplies of prescriptions are not available.

How much will my prescription drugs cost?

Depending on the tier of your prescription drug, you may owe a copay for your medication or you may pay coinsurance after meeting your deductible. The Drug Pricing tool can help you compare prices for specific drugs at pharmacies near you.

• Compare drug prices

Using a coupon? You may use insurance in combination with manufacturer coupons when filling a prescription. Only the amount paid out of pocket will be credited toward your deductible and/or coinsurance out-of-pocket maximum. If the coupon pays for the entire cost of the drug, you will have nothing applied toward your deductible and/or coinsurance out-of-pocket maximum.

Note: Drug prices are subject to change and are not determined by UnitedHealthcare or Golden Rule Insurance Company. These lists may not include all medications, and not all medications listed may be covered by your plan. The benefit plan documents provided by your health plan are the most accurate source for checking to see if a medication is covered. When a Prescription Drug Product is excluded from coverage, you and your representative may request an exception to gain access to the excluded Prescription Drug Product. To make a request, contact us in writing or call the toll-free number on your ID card. We will notify you of our determination within 72 hours.

Short Term Medical plan pharmacy and drug coverage information

Short Term Medical plans are underwritten by Golden Rule Insurance Company.

Is my medication covered?

The cost of covered prescriptions will vary depending on the plan you have. You may pay a copay, or your medication may be subject to deductible and coinsurance. The Drug Pricing tool can help you compare prices for specific drugs at pharmacies near you.

• Prescription Drug List (PDL) - Effective July 1, 2019
• Prescription Drug List (PDL) - Effective January 1, 2020
• Look up a medication

Where can I get my prescription filled?

The pharmacy network includes large national chains and many local, community pharmacies.

• Find a network pharmacy

Note: Mail-order refills and 90-day supplies of prescriptions are not available.

How much will my prescription drugs cost?

Depending on the tier of your prescription drug, you may owe a copay for your medication or you may pay coinsurance after meeting your deductible. The Drug Pricing tool can help you compare prices for specific drugs at pharmacies near you.

• Compare drug prices

Using a coupon? You may use insurance in combination with manufacturer coupons when filling a prescription. Only the amount paid out of pocket will be credited toward your deductible and/or coinsurance out-of-pocket maximum. If the coupon pays for the entire cost of the drug, you will have nothing applied toward your deductible and/or coinsurance out-of-pocket maximum.

Note: Drug prices are subject to change and are not determined by UnitedHealthcare or Golden Rule Insurance Company. These lists may not include all medications, and not all medications listed may be covered by your plan. The benefit plan documents provided by your health plan are the most accurate source for checking to see if a medication is covered. When a Prescription Drug Product is excluded from coverage, you and your representative may request an exception to gain access to the excluded Prescription Drug Product. To make a request, contact us in writing or call the toll-free number on your ID card. We will notify you of our determination within 72 hours.

Short Term Medical plan pharmacy and drug coverage information

Short Term Medical plans are underwritten by Golden Rule Insurance Company.

Is my medication covered?

The cost of covered prescriptions will vary depending on the plan you have. You may pay a copay, or your medication may be subject to deductible and coinsurance. The Drug Pricing tool can help you compare prices for specific drugs at pharmacies near you.

For plan’s term length quoted in days:

• Prescription Drug List (PDL) - Effective July 1, 2019
• Prescription Drug List (PDL) - Effective January 1, 2020
• Look up a medication

For plan’s term length quoted in months:

• Prescription Drug List (PDL) - Effective July 1, 2019
• Prescription Drug List (PDL) - Effective July 1, 2020
• Look up a medication

Where can I get my prescription filled?

The pharmacy network includes large national chains and many local, community pharmacies.

• Find a network pharmacy

Note: Mail-order refills and 90-day supplies of prescriptions are not available.

How much will my prescription drugs cost?

Depending on the tier of your prescription drug, you may owe a copay for your medication or you may pay coinsurance after meeting your deductible. The Drug Pricing tool can help you compare prices for specific drugs at pharmacies near you.

• Compare drug prices

Using a coupon? You may use insurance in combination with manufacturer coupons when filling a prescription. Only the amount paid out of pocket will be credited toward your deductible and/or coinsurance out-of-pocket maximum. If the coupon pays for the entire cost of the drug, you will have nothing applied toward your deductible and/or coinsurance out-of-pocket maximum.

Note: Drug prices are subject to change and are not determined by UnitedHealthcare or Golden Rule Insurance Company. These lists may not include all medications, and not all medications listed may be covered by your plan. The benefit plan documents provided by your health plan are the most accurate source for checking to see if a medication is covered. When a Prescription Drug Product is excluded from coverage, you and your representative may request an exception to gain access to the excluded Prescription Drug Product. To make a request, contact us in writing or call the toll-free number on your ID card. We will notify you of our determination within 72 hours.

Short Term Medical plan pharmacy and drug coverage information

Short Term Medical plans are underwritten by Golden Rule Insurance Company.

Is my medication covered?

The cost of covered prescriptions will vary depending on the plan you have. You may pay a copay, or your medication may be subject to deductible and coinsurance. The Drug Pricing tool can help you compare prices for specific drugs at pharmacies near you.

• Prescription Drug List (PDL) - Effective July 1, 2019
• Prescription Drug List (PDL) - Effective July 1, 2020

Where can I get my prescription filled?

The pharmacy network includes large national chains and many local, community pharmacies.

• Find a network pharmacy

Note: Mail-order refills and 90-day supplies of prescriptions are not available.

How much will my prescription drugs cost?

Depending on the tier of your prescription drug, you may owe a copay for your medication or you may pay coinsurance after meeting your deductible. The Drug Pricing tool can help you compare prices for specific drugs at pharmacies near you.

• Compare drug prices

Using a coupon? You may use insurance in combination with manufacturer coupons when filling a prescription. Only the amount paid out of pocket will be credited toward your deductible and/or coinsurance out-of-pocket maximum. If the coupon pays for the entire cost of the drug, you will have nothing applied toward your deductible and/or coinsurance out-of-pocket maximum.

Note: Drug prices are subject to change and are not determined by UnitedHealthcare or Golden Rule Insurance Company. These lists may not include all medications, and not all medications listed may be covered by your plan. The benefit plan documents provided by your health plan are the most accurate source for checking to see if a medication is covered. When a Prescription Drug Product is excluded from coverage, you and your representative may request an exception to gain access to the excluded Prescription Drug Product. To make a request, contact us in writing or call the toll-free number on your ID card. We will notify you of our determination within 72 hours.