GatorGradCare Pharmacy, August 16, 2017- August 15, 2020

GatorCare partners with MagellanRx Management to provide prescription drug benefits.

Review Summary of Benefits and Coverage for more information.

Your GatorCare ID card includes pharmacy information.


Pharmacy Benefit Highlights

 

  • Medications are categorized into 5 tiers and impact your out-of-pocket costs; the 5 tiers are outlined below.
  • Beginning 8/16/2017: $100 per member pharmacy (Rx) benefit year deductible must be satisfied for Rx Tiers 2-5, with a family cap of $400.
    • Tier 1 medications do not apply toward Rx benefit year deductible.
    • Member pays the first $100 for medications in Tiers 2-5, then coinsurance benefits apply.
    • Rx deductible does not apply to medical deductible, but counts towards medical maximum out-of-pocket.
    • For more information on the Pharmacy Deductible and examples, view the GatorCare Pharmacy Deductible page
  • Member pays the brand copay plus the difference in cost between the brand and generic if brand product is chosen when a generic equivalent is available.
  • There is a mandatory 90-day supply at either retail or mail order for Tier 1 or 2 maintenance medications following a maximum of two 30-day fills at retail. Controlled drugs including, but not limited to, medications used to treat anxiety, sleep, pain, and hyperactivity disorders are EXCLUDED from the mandatory 90-day Rx rule.

How to Look Up the Tier of a Specific Medication

  • Step 1. Visit the GatorCare Formulary Lookup Tool.
  • Step 2. After navigating to this page, enter the name of the drug on the left hand side.
  • Step 3. After several seconds, possible matches appear on the right side of the screen. The tier to which the drug is offered through GatorCare is found along with other alternative drugs and information.
  • Step 4. By clicking on the ‘find alternative drugs’ link, a member can determine if an alternative medication for the drug may be available on a lower tier, reducing the member’s out-of-pocket expenses.

Tier 1 Option with the lowest out-of-pocket expenses and a pharmacy deductible does not apply

Generic medications

Up to a 30-day supply
  • You pay 25% of the total price of the medication with a $10 minimum payment, and a $20 maximum payment
Up to a 90-day supply
  • You pay 25% of the total price of the medication with a $25 minimum payment, and a $50 maximum payment.

Maintenance medication

  • After filling a maintenance medication two times, you are required to have it filled with a 90-day prescription.  There are a few exceptions to this, including, controlled drugs for anxiety, sleep, pain, and hyperactivity disorders.  For clarification, please contact MagellanRx Management, at 800-651-8921.
Tier 2 Preferred Brand Medications – a pharmacy deductible applies and you are required to pay the first $100 out-of-pocket expenses to satisfy the deductible

Up to a 30-day supply
  • You pay 25% of the total price of the medication with a $25 minimum payment, and a $50 maximum payment.
Up to a 90-day supply
  • You pay 25% of the total price of the medication with a $62.50 minimum payment, and a $125 maximum payment.

Maintenance medication

  • After filling a maintenance medication two times, you are required to have it filled with a 90-day prescription.  There are a few exceptions to this, including, controlled drugs for anxiety, sleep, pain, and hyperactivity disorders.  For clarification, please contact MagellanRx Management, at 800-651-8921.
Tier 3 Preferred Specialty Medications – a pharmacy deductible applies and you are required to pay the first $100 out-of-pocket expenses to satisfy the deductible

Up to a 30-day supply
  • You pay 25% of the total price of the medication with a $50 minimum payment, and a $100 maximum payment.
90-day supplies are not available for Tier 3 medications
Tier 4 Non-preferred Brand Medications – a pharmacy deductible applies and you are required to pay the first $100 out-of-pocket expenses to satisfy the deductible

Up to a 30-day supply
  • You pay 40% of the total price of the medication with a $70 minimum payment and a $240 maximum payment
Up to a 90-day supply
  • You pay 40% of the total price of the medication with a $175 minimum payment and a $600 maximum payment
Tier 5 Non-preferred Specialty Medications – a pharmacy deductible applies and you are required to pay the first $100 out-of-pocket expenses to satisfy the deductible

Up to a 30-day supply
  • You pay 40% of the total price of the medication with a $70 minimum payment and a $240 maximum payment
90-day supplies are not available for Tier 5 medications

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