88Sears Prescription Drug Coverage

Your medical plans include coverage for prescription drugs. Here are some things to keep in mind:ƒ

  • Medical and Prescription Drug coverage are provided by your medical provider for all plans except Blue Cross Blue Shield (BCBS) of Illinois. OptumRx will continue to provide coverage for BCBS members. Call OptumRx at 1-844-368-8771 for more information.ƒ
  • The Kmart Pharmacy will continue to be the primary retail pharmacy within the network. Walgreens, Walmart and Target/CVS pharmacies will be considered out-of-network when a Kmart Pharmacy is within a 10-mile radius of where allowed by state law.
BASIC BCBS/OPTUMRX
BASIC KAISER
ENHANCED BCBS/OPTUMRX
ENHANCED KAISER
Preventive Drugs
(determined by the insurance carrier, as required by the Affordable Care Act)
You pay $0. You must have a doctor’s prescription for the medication – even over the counter (OTC) – and you must use an in-network retail pharmacy or mail-order service.
30-DAY RETAIL
Tier 1: Generic formularyYou pay 100% until you have met the deductible, then you pay 20%.You pay $10 co-pay.
Tier 2: Preferred formularyYou pay 100% until you have met the deductible, then you pay 20%.You pay $40 co-pay.
Tier 3: Non-Preferred and Specialty formulary optionsYou pay 100% until you have met the deductible, then you pay 20%.You pay $60 co-pay.
90-DAY MAIL ORDER
Tier 1: Generic formularyYou pay 100% until you have met the deductible, then you pay 20%.You pay $25 co-pay.
Tier 2: Preferred formularyYou pay 100% until you have met the deductible, then you pay 20%.You pay $100 co-pay.
Tier 3: Non-Preferred and Specialty formulary optionsYou pay 100% until you have met the deductible, then you pay 20%.You pay $150 co-pay.

REMEMBER!

All benefits-eligible associates must be enrolled in a medical plan to receive prescription drug coverage.

PREVENTIVE CARE MEDICATION REMINDER

Under the health reform law (Affordable Care Act), pharmacy benefit plans must cover certain Preventive Care Medications at 100%—without charging a copay, coinsurance or deductible. These products are available at no cost to you under the Basic and Enhanced health plans.

DO YOU TAKE MEDICATION ON AN ONGOING BASIS?

Stay on track with 90-day prescriptions. Instead of visiting your pharmacist and paying for a refill every month, ask your doctor to write a 90-day prescription. Why?

  • ƒYou’re less likely to miss a dose with a larger supply. And you could also save money.ƒ
  • Pick up your medication in-store or get medication through mail delivery.

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