Understanding Your Pharmacy Benefits
Identifying Your Unity Prescription Drug Benefit
To verify the pharmacy benefit that you have, please refer to your Summary of Benefits and Coverage or Schedule of Benefits. You may also login to MyChart to check what pharmacy benefit that you have and what your copay amounts would be. The formulary determines your copay for a medication and whether or not the medication requires a Prior Authorization for coverage. The most common benefits are described. Your employer may have purchased a plan that is a modification of the listed descriptions.
Two-Tier Drug Benefits
- All non-formulary and restricted drugs require Prior Authorization for coverage
- Generic drugs require a Tier 1 copayment
- Brand name drugs require a Tier 2 copayment
Three-Tier Drug Benefits
- Restricted drugs require Prior Authorization for coverage
- Generic drugs require a Tier 1 copayment
- Brand name drugs require a Tier 2 copayment
- Non-formulary drugs require a Tier 3 copayment
- Some drugs are covered only under the Specialty Pharmaceuticals Program and require a $100 copayment
High Deductible HSA Benefits
- All non-formulary and restricted drugs require Prior Authorization for coverage
- All medications require 100% coinsurance until the member or family deductible has been met
- Once the deductible has been met, a copayment is not required for covered medications for the remainder of the benefit year
- Your pharmacy must submit claims for medications charged at 100% coinsurance so that charges are counted toward the deductible
No Unity Drug Coverage
- Your employer may have purchased medical coverage through Unity, but not prescription drug coverage
- You may receive your prescription drug coverage through another organization
- Members covered under the State of Wisconsin health insurance program receive drug coverage through Navitus
- BadgerCare Plus members must contact the State Medicaid program at 800-362-3002 for information about their drug coverage
