Prescription Drug Coverage
Access to affordable prescription drugs is just as important as the ability to choose your own doctor. That's why many of our health insurance plans include a prescription drug benefit. These prescription drug benefits vary depending on the type of health plan you choose.
Pharmacy Benefit Basics
When considering a health insurance plan and out-of-pocket costs for prescription drugs, you should know about:
- Tier Pricing: (Copay plans only.) Each medication is placed in a tier, a numbered level. There is a set copay for drugs in each tier.
- Deductible: With some of our plans prescription drugs count toward the plan deductible. Once you meet the deductible, the plan starts paying for covered expenses, including prescription drugs.
- Coinsurance: For lower premiums, some plans include a coinsurance amount (a percentage of the cost you pay) for drugs once the plan deductible is satisfied.
- Mental Health: Prescription drugs for mental disorders or substance abuse are not covered unless mental disorders and substance abuse is a covered benefit on your plan. This includes prescription drugs for ADD, ADHD, anxiety, depression and others.
Specific Pharmacy Information
For pharmacy information, select the applicable link below. Existing members, please reference your ID card for your effective date and insurance company name.
Golden Rule Insurance Company
Use this link if:
- You are an existing Golden Rule Insurance Company member.
- You are a shopper seeking Short Term coverage.
Oxford
Use this link if:
- You are an existing Oxford Health Insurance member (effective 1-1-2017 or later).
- You are a shopper seeking an ACA plan in NJ.
Optum-Rx
Use this link if:
- You are an existing Golden Rule Insurance Company or Oxford Health Insurance member and you want to manage your current prescription drug benefits.
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