Pharmacy Program

What is the Pharmacy Program?

The University works with Prime Therapeutics and Fairview Specialty Pharmacy to ensure access to an open formulary of medications for all eligible employees.

Most medications are covered through Prime Therapeutics, whereas specialty medications for complex or ongoing medical conditions are provided through Fairview Specialty Pharmacy.

 

Why Do We Need a Prescription Drug Benefit Program?

Many medications can be prohibitively expensive without some sort of insurance or drug benefit program. The University and Prime Therapeutics work together to secure a wide range of safe, effective, and high-quality medications at cost-effective prices for employees and their dependents. And Fairview Specialty Pharmacy provides support with specialty medications to help you achieve the best outcomes.

 

Who is Eligible?

Once you’ve signed up for your medical program through MyU, you are also enrolled in the prescription drug benefit program. You’ll receive a separate ID card for your prescription benefit from Prime Therapeutics that you can also use for Fairview Specialty Pharmacy. Present the card at your local pharmacy when you have your prescription filled.

 

Questions About Your Pharmacy Benefits?

Call Prime Therapeutics at 1-800-727-6181 or visit the Prime Therapeutics website.

For specialty medications, call Fairview Specialty Pharmacy at 612-672-5289 or 1-877-509-5115 or visit the Fairview Specialty Pharmacy website.

 

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Prescription Costs

Prime Therapeutics covers a 30-day supply of prescription medications (including insulin) through network pharmacies at the following levels:

  • $0 copay for select preventive medications specified in the Affordable Care Act, including contraceptives in the Generic Plus category. Medica HSA covers these medications at 100%.
  • $10 copay for Generic Plus (Tier 1) medications, which covers all generic drugs and certain preferred brand drugs for which there is no generic therapeutic equivalent
  • $30 copay for Brand Formulary (Tier 2) medications, which includes all other brand name medications listed on the formulary
  • $75 copay for Non-Formulary (Tier 3) medications, which includes all covered brand name medications not listed on the formulary

The annual out-of-pocket maximum is $750 per person and $1,500 per family.

For Medica HSA, you can have your prescriptions covered first under the account or applied to the annual deductible until it is met. After that, the medical plan pays 90% of the pharmacy expenses.

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What Kinds of Prescription Drugs are Covered?

The list of drugs covered through Prime Therapeutics provides you with safe, effective, high-quality, cost-effective medications to ensure the best medical results while also reducing the overall costs for providing prescription benefits.

Prime Therapeutics has a strong emphasis on the use of generic medications to help control the cost of prescription drugs. Generic versions of brand name medications are clinically proven to be just as effective as their brand name counterparts at a fraction of the cost.

The University of Minnesota UPlan Formulary, found on the Prime Therapeutics website, lists the medications that are covered by the program.

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Specialty Medications

Specialty drugs are provided through Fairview Specialty Pharmacy. Specialty drugs are generally prescribed for people with complex or ongoing medical conditions and the drugs themselves are often subject to unique storage or shipment requirements.

Additionally, members using specialty medications receive education and support from a health care professional through Fairview Specialty Pharmacy due to the complexity of use and the potential for some serious side effects. Contact your doctor or pharmacist if you have questions about correctly using your prescribed specialty medications.

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Pharmacy Network

Prime Therapeutics has a broad Minnesota and national retail pharmacy network that includes popular chains, clinic and hospital pharmacies, independent pharmacies, and a home delivery mail service pharmacy.

Fairview Specialty Pharmacy provides home delivery or pick-up service for specialty drugs at Fairview clinic and hospital retail pharmacies and at Essentia Health and Northland in Duluth.

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Medication Therapy Management (MTM)

Medication Therapy Management is a patient care service offered to eligible UPlan members to help you improve the quality and effectiveness of your medication therapy program. Learn more about the MTM program on the Medication Therapy Management page.

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