Prescription Drug Coverage
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.
Some medications require prior authorization to be eligible for coverage. The most common drugs are listed here.
Benlysta
Cosentyx
Dupixent
Enbrel
Gilenya
Harvoni
Humira
Ibrance
Imbruvica
Orencia
Pomalyst
Praluent
Repatha
Simponi
Tremfya
Xelianz
Xolair
Please call 1-800-657-8205 if your medication is not on this list.
Where can I get my prescription filled?
The pharmacy network includes large national chains and many local, community pharmacies.
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.
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.
Long-term health plan pharmacy and drug coverage information
Long-term health 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.
Some medications require prior authorization to be eligible for coverage. The most common drugs are listed here.
Benlysta
Cosentyx
Dupixent
Enbrel
Gilenya
Harvoni
Humira
Ibrance
Imbruvica
Orencia
Pomalyst
Praluent
Repatha
Simponi
Tremfya
Xelianz
Xolair
Please call 1-800-657-8205 if your medication is not on this list.
Where can I get my prescription filled?
The pharmacy network includes large national chains and many local, community pharmacies.
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.
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.
Learn more about Oxford Health Insurance ACA plans
Affordable Care Act plans underwritten by Oxford Health Insurance are available in New Jersey.
Oxford Health Insurance ACA plan pharmacy and drug coverage information
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.
Where can I get my prescription filled?
The pharmacy network includes large national chains and many local, community pharmacies.
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.
Note: Drug prices are subject to change and are not determined by UnitedHealthcare or Oxford Health Insurance, Inc. 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.
Some medications require prior authorization to be eligible for coverage. The most common drugs are listed here.
Benlysta
Cosentyx
Dupixent
Enbrel
Gilenya
Harvoni
Humira
Ibrance
Imbruvica
Orencia
Pomalyst
Praluent
Repatha
Simponi
Tremfya
Xelianz
Xolair
Please call 1-800-657-8205 if your medication is not on this list.
Where can I get my prescription filled?
The pharmacy network includes large national chains and many local, community pharmacies.
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.
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.
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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.
Some medications require prior authorization to be eligible for coverage. The most common drugs are listed here.
Benlysta
Cosentyx
Dupixent
Enbrel
Gilenya
Harvoni
Humira
Ibrance
Imbruvica
Orencia
Pomalyst
Praluent
Repatha
Simponi
Tremfya
Xelianz
Xolair
Please call 1-800-657-8205 if your medication is not on this list.
Where can I get my prescription filled?
The pharmacy network includes large national chains and many local, community pharmacies.
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.
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.
TriTerm Medical plan pharmacy and drug coverage information
TriTerm 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.
Some medications require prior authorization to be eligible for coverage. The most common drugs are listed here.
Benlysta
Cosentyx
Dupixent
Enbrel
Gilenya
Harvoni
Humira
Ibrance
Imbruvica
Orencia
Pomalyst
Praluent
Repatha
Simponi
Tremfya
Xelianz
Xolair
Please call 1-800-657-8205 if your medication is not on this list.
Where can I get my prescription filled?
The pharmacy network includes large national chains and many local, community pharmacies.
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.
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) by category
- Look up a medication by name
For plan’s term length quoted in days:
- Prescription Drug List (PDL) by category
- Look up a medication by name
For plan’s term length quoted in months:
Some medications require prior authorization to be eligible for coverage. The most common drugs are listed here.
Benlysta
Cosentyx
Dupixent
Enbrel
Gilenya
Harvoni
Humira
Ibrance
Imbruvica
Orencia
Pomalyst
Praluent
Repatha
Simponi
Tremfya
Xelianz
Xolair
Please call 1-800-657-8205 if your medication is not on this list.
Where can I get my prescription filled?
The pharmacy network includes large national chains and many local, community pharmacies.
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.
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.
Health ProtectorGuard plan pharmacy and drug coverage information
Health ProtectorGuard fixed indemnity plans are underwritten by Golden Rule Insurance Company.
Is my medication covered?
If you have a Choice Plus, Primary Preferred, Select Preferred, or Premier Plus plan, the plan includes a fixed benefit for a set number of prescription fills per person, per calendar year subject to plan provisions, exclusions and limitations. This benefit applies to any FDA-approved medication – generic or brand – for which you submit a claim.
Plus, the Optum Perks discount card included with all Health ProtectorGuard plans offers discounts for FDA-approved prescription medication. It is not insurance. It is a discount program only.
Where can I get my prescription filled?
Health ProtectorGuard plans that include a prescription drug benefit do not require you to stay within a network. Visit any pharmacy in the U.S., pay for your prescription, and include the receipt when you submit your claim.
The Optum Perks discount card included with all plans is honored at most U.S. pharmacies. The amount of the discount can vary from one pharmacy to another. To check if a specific pharmacy participates, please call 1-866-407-8901.
How much will my prescription drugs cost?
Plans come with an Optum Perks discount card that can provide savings of up to 30-80%.* The Optum Perks card is not insurance; it is a discount program only.
Additionally, the Choice Plus, Primary Preferred, Select Preferred, and Premier Plus plans include a fixed benefit for a set number of prescription fills per person, per calendar year. The plan includes benefits for both brand name and generic drugs, with copays varying depending on which plan you have.
Note: If you have a major medical plan, you may need to stay with certain networks and providers to get the most coverage out of that plan. Be sure to take that into consideration.
* Based on pharmacy’s usual and customary price. Actual savings may vary.
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