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 $125 per covered person, with a deductible cap of $500 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 $125, members will pay the cost of the drug, until the $125 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 0, 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.

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 employees will exclusively use the UF Health Jacksonville Ambulatory Pharmacy for specialty medications. UF Health Central Florida employees will exclusively use the UF Health Leesburg Hospital Pharmacy for specialty medications.


Prescriptions, up to 34-day retail supply:

 Tier 0: Value Based  0% coinsurance -includes Healthcare Reform medications covered at no cost to member (no Rx CYD applies)
 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 0: Value Based  0% coinsurance -includes Healthcare Reform medications covered at no cost to member (no Rx CYD applies)
 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 GatorCare Formulary Look-Up Tool, to get more information on your prescriptions. After navigating to this page, enter the name of the drug on the left hand side in the Drug Name Search field. After several seconds, possible matches will appear under the Drug Name Search field.  Click on the drug you’re looking for.  All matches for that drug will be listed in the middle of the screen under Drug Details including the tier to which the drug is offered through the GatorCare formulary. 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 the GatorCare dedicated line at Magellan Rx Management at (800) 651-8921.


Pharmacy Network

Magellan Rx Management’s network includes more than 60,000 retail pharmacies. All major chains are included (UF Health Pharmacies in Gainesville, Jacksonville, and Leesburg, 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.magellanrx.com or call customer service at 800-651-8921.

In certain cases of specialty medications, restrictions may require they be filled through the UF Health 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 UF Health Pharmacies, as they are in-network and offer member discounts.