Pharmacy Benefits

Prescription Benefits *

Beginning January 1, 2017, GatorCare members enrolled in the Prime, Prime Plus, Premium, Healthy Rewards HRA, and Options plans will be required to satisfy a prescription drug deductible for purchases of all Tier 2-5 prescription drugs before the plan’s prescription benefits apply.  The deductible amount is $100 per covered person, with a deductible cap of $400 per family.  Each member will pay the deductible plus any applicable coinsurance, up to the cost of the drug. For drugs that cost less than $100, members will pay the cost of the drug, until the $100 prescription drug deductible is met.  The deductible applies regardless of whether you purchase your prescription from a retail or mail order pharmacy.

Prescriptions, up to 34-day retail supply:

 Tier 1: Generic  25% coinsurance with $10 minimum to $20 maximum (no Rx CYD applies)
 Tier 2: Preferred Brands  25% coinsurance with $25 minimum to $50 maximum after Rx CYD *
 Tier 3: Preferred Specialty  25% coinsurance with $50 minimum to $100 maximum after Rx CYD *
 Tier 4: Non-Preferred Brands  40% coinsurance with $70 minimum to $240 maximum after Rx CYD *
 Tier 5: Non-Preferred Specialty  40% coinsurance with $70 minimum to $240 maximum after Rx CYD *

Prescriptions, 90 day supply retail and mail order:

Applies to in-network pharmacies only for eligible prescriptions following initial 30-34 day fill
 Tier 1: Generic  25% coinsurance with $25 minimum to $50 maximum (no Rx CYD)
 Tier 2: Preferred Brands  25% coinsurance with $62.50 minimum to $125 maximum after Rx CYD *
 Tier 3: Preferred Specialty  N/A
 Tier 4: Non-Preferred Brands  40% coinsurance with $175 minimum to $600 maximum after Rx CYD *
 Tier 5: Non-Preferred Specialty  N/A
 * The Pharmacy deductible does not apply to GatorGradCare or Healthy Rewards HSA.