Pharmacy Benefits

Prescription Benefits *

Beginning January 1, 2017, GatorCare members enrolled in the Prime, Prime Plus, Premium, Healthy Rewards HRA, and Options plans and beginning August 16, 2017, members enrolled in the GatorGradCare plan 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.

Effective August 16, 2017 for members enrolled in the GatorGradCare plan and beginning January 1, 2018 for members enrolled in other plans, there will be a mandatory 90-day supply at retail or mail delivery for maintenance medications, following two 30-day grace fills.

Effective January 1, 2018, specialty medications will be required to be filled at one of the UF Health pharmacies or through Magellan’s specialty pharmacy. UF Health Shands employees in Gainesville will exclusively use the UF Health- Shands pharmacies in Gainesville for specialty medications. UF Health Jacksonville, UFJPI, College of Medicine Jacksonville, and UF Proton Therapy members will exclusively use the UF Health Ambulatory Pharmacy – Jacksonville for specialty Hepatitis C medications.

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 Healthy Rewards HSA.