Pharmacy Benefits and Network

Pharmacy Benefits

GatorCare members are 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. Representatives at the Magellan Rx Call Center have access to the GatorCare formulary and can review the formulary for a prescribed medication, determine it’s tier, and if not on Tier 1, suggest other medications in the same therapeutic class found in Tier 1. They can be reached at 800-651-8921. * The pharmacy deductible does not apply to Healthy Rewards HSA plans.

GatorCare plans require a mandatory 90-day supply at retail or mail delivery for Tier 1 and Tier 2 maintenance medications, following two 30-day grace fills.  Learn more about the mandatory 90-day supply here. Some maintenance medications are excluded from the mandatory 90-day supply. Learn which maintenance medications are excluded from the mandatory 90-day supply here.

Specialty medications must 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

How do I learn which tier my prescription falls under?

Open the 2019 Formulary, also known as the Pharmacy Look-Up Tool, to get more information on your prescriptions. Once you open the tool, enter the name of the drug on the left hand side.  After several seconds, possible matches appear on the right side of the screen.  The tier to which the drug is offered through the GatorCare formulary is found along with other alternative drugs and information.  By clicking on the ‘find alternative drugs’ link, a member can determine if an alternative medication for the drug may be available on the formulary on a lower tier, reducing the member’s out-of-pocket expenses.

For a printable version of the formulary, please visit this page.

For more information and assistance, members may contact MagellanRx at 800-651-8921.

Pharmacy Network

Magellan Rx Management’s network includes more than 60,000 retail pharmacies. All major chains are included (Shands Pharmacies in Gainesville, UF Student Health Care Center, Walgreens, CVS, Publix, Winn-Dixie, Target, Kroger, etc.).  To learn more or verify if a pharmacy is in-network, visit the Magellan Rx Management website at GatorCare.magellanpharmacysolutions.com or call customer service at 800-651-8921.

In certain cases of specialty medications, restrictions may require they be filled through the Shands Pharmacy or through specific specialty pharmacies authorized by Magellan Rx Management.  Prior to having a specialty medication filled, members should contact Magellan Rx Management at 800-651-8921.

All members are encouraged to use the Shands Pharmacies, as they are in-network and offer member discounts.