The University works with Prime Therapeutics and Fairview Specialty Pharmacy to ensure access to a select 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. When you chose your medical plan you received a separate ID card for your prescription benefit from Prime Therapeutics that you can also use for Fairview Specialty Pharmacy.
The list of drugs in the formulary through Prime Therapeutics provides safe, effective, high-quality, cost-effective medications to ensure the best medical results. The UPlan and the pharmacy managers have a strong emphasis on the use of generic drugs to help control the cost of prescription drugs.
Prime Therapeutics covers a 30-day supply of prescription medications (including insulin) through network pharmacies at the following levels:
- $0 copayment for select preventive medications specified in the Affordable Care Act, including all contraceptives at the Generic Plus level. Medica HSA covers these medications at 100%.
- $10 copayment for Generic Plus (Tier 1) drugs, which covers all generic drugs and certain preferred brand drugs for which there is no generic therapeutic equivalent.
- $30 copayment for Brand Formulary (Tier 2) drugs includes all other brand name medications listed on the formulary.
- $75 copayment for Non-Formulary (Tier 3) drugs includes all covered brand name drugs not listed on the formulary.
For Medica HSA, prescriptions can be covered either with money from the account or applied to the annual deductible until it is met. After that, the medical plan pays 90 percent of pharmacy expenses in the HSA.
Prime Therapeutics has a broad Minnesota and national retail pharmacy network that includes popular pharmacy chains, clinic and hospital pharmacies, independent pharmacies, and a home delivery mail service pharmacy. Fairview Specialty Pharmacy provides home delivery or pick-up service of specialty drugs at Fairview clinic/hospital retail pharmacies and at Essentia Health and Northland in Duluth.