It is easy to fill prescriptions at any In-Network pharmacy (Target, Walmart, and many more). Just present your Health Plan ID card, and the pharmacist will tell you your share of the cost (if any).
As of September 1, 2020, EnvisionRx changed its name to Elixir. Only the name changed. There is no change to your Health Plan ID card or which pharmacies are In-Network.
The Elixir Covered Medication Search tool gives you immediate access to information about prescription drugs covered by the Health Plan. Use it to help your doctor or nurse practitioner prescribe covered medications.
When your health care provider prescribes a medication, you may want to check if there is an effective medication that costs you less (such as an over-the-counter drug or a Generic Preferred drug).
|COVERAGE TIER||TIER NAME||YOUR SHARE OF THE TOTAL COST (IN-NETWORK) |
PER PRESCRIPTION FILL
|Approved Over-the-Counter||OTC||You pay $0 when prescribed and dispensed at an on-site clinic|
|Approved Preventive||ACA PV||You pay $0|
|Generic Preferred||Tier 1||You pay 10% coinsurance ($5 minimum); some $0 copay exceptions noted in the Covered Medication Search|
|Generic Non-Preferred||Tier 2||You pay 10% coinsurance ($10 minimum)|
|Brand-Name Preferred||Tier 3||You pay 20% coinsurance ($10 minimum)|
|Brand-Name Non-Preferred||Tier 4||You pay 40% coinsurance ($10 minimum)|
|Specialty Preferred||Tier 5||You pay 10% coinsurance ($100 minimum, $300 maximum)|
|Specialty Non-Preferred||Tier 6||You pay 20% coinsurance ($200 minimum, $600 maximum)|
For ACA PV, certain drugs covered only when dispensed at an on-site clinic; if a clinic is not available at your mine/office, these drugs are covered 100% at an In-Network retail pharmacy. For more details and restrictions, see Highlights of the Plan.
Elixir mail-order pharmacy:
The Summary Plan Description (SPD) has more details about this benefit, such as: