Overview

When you enroll in a Masonite medical plan, you automatically receive prescription drug coverage through OptumRx.

The cost of your prescription drugs under each medical plan depends on the tier of the medication:

Generic drugs contain the same active ingredients as their brand-name equivalents and meet the same federal standards for safety, but typically cost significantly less.
Formulary drugs are brand-name medications that are favored by a prescription plan based on drug effectiveness and cost.
Non-formulary drugs are brand-name medications that are not on a prescription plan's favored list (or formulary) based on drug effectiveness and cost. They may still be covered, but may require prior authorization and cost more.

	Basic HSA Plan	PPO Plan	PPO Plan
Deductible	Rx included in medical deductible
Out-of-pocket maximum	Medical and Rx maximum combined
Prescription drugs	Retail or mail order	Retail (up to 31-day supply)	Mail order (90-day supply)
Generic drugs	You pay 20% after deductible (in-network); 50% after deductible (out-of-network)	You pay $15 copay	You pay $37.50 copay
Formulary drugs	You pay 20% after deductible (in-network); 50% after deductible (out-of-network)	You pay $40 copay after deductible	You pay $100 after deductible
Non-formulary drugs	You pay 20% after deductible (in-network); 50% after deductible (out-of-network)	You pay $55 copay after deductible	You pay $137.50 after deductible
Specialty drugs	You pay 20% after deductible (in-network); 50% after deductible (out-of-network)	You pay 20% after deductible (up to $200 maximum)	Not covered
Maintenance drugs	Contact OptumRx for a complete list of maintenance medications available without meeting your deductible and with no co-insurance — FREE!
Smoking cessation medications and specific diabetes medications and supplies	FREE IN EACH PLAN (Contact OptumRx for a list of eligible medications before filling your prescription)

Certain diabetic or weight loss drugs require preauthorization

The cost of prescription drugs is rising faster than many other health care services and supplies. But, there are ways for you to save:

Ask your doctor about generic medications. Generic medications are generally just as effective as brand-name medications, yet typically cost between 30% and 75% less than brand-name drugs.
Use the mail order feature. If you regularly take medication to treat a long-term condition — such as an allergy, heart disease, high blood pressure, or diabetes — the mail order prescription program is a convenient and money-saving option for you. Your prescription plan covers three fills of maintenance medications at participating retail pharmacies. After that, prescriptions for long-term medications are required to be filled via mail order or by visiting a CVS pharmacy for a 90-day supply.

Website
OptumRx

Phone
1.844.783.1396

These form(s) are in Adobe Acrobat Reader (PDF) format and are available for downloading and printing.

Prescription Drugs