Pharmacy BenefitsPharmacy Benefits

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  1. Compound Prescription Limitation
  2. Prescriptions with an Over-the-Counter Equivalent
  3. Maximize your AlaskaCare Pharmacy Benefits

NEW! Important pharmacy benefit changes effective January 1, 2018!

All three of the AlaskaCare medical options have the same prescription drug coverage.

Compound Prescription Limitation

Effective January 1, 2018, the AlaskaCare Employee Health Plan pharmacy benefits will no longer cover bulk powders/chemicals/products or other non-FDA approved drugs used in prescription compounding. Compound medications formulated from bulk powder compounds and bioidentical hormones will not be covered prescription drugs because they are not drug products approved by the FDA. Compounds that utilize at least one non-bulk, FDA-approved legend drug may be considered for coverage. If this impacts you, talk with your doctor or pharmacist about alternative options.

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Prescriptions with an Over-the-Counter Equivalent

Effective January 1, 2018, the AlaskaCare Employee Health Plan will not pay for prescription drugs when an over-the-counter equivalent is available. This applies even if prescribed or recommended by your health care provider. Talk to your doctor or pharmacist about over-the-counter alternatives that may be less expensive. Please note this change will not affect over-the-counter medications required to be covered under the Affordable Care Act, such as aspirin.

AlaskaCare 2018 pharmacy plan summaries
Prescription Tier Coinsurance Min. Covered Person Payment Max. Covered Person Payment
Retail 30 Day at Network Pharmacy
Generic prescription drug 80% $10 $50
Preferred brand-name prescription drug 75% $25 $75
Non-preferred brand-name prescription drug 65% $80 $150
Mail Order 31-90 Day at Network Pharmacy
Prescription Tier Copayment
Generic prescription drug $20
Preferred brand-name prescription drug $50
Non-preferred brand-name prescription drug $100
Out-of-Network Pharmacy
Coinsurance for all prescription drugs 60%
Out-of-Pocket Limit
Annual individual out-of-pocket limit $1,000
Annual family out-of-pocket limit $2,000
Effective: Jan. 1 - Dec. 31, 2018

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Maximize your AlaskaCare Pharmacy Benefits

The AlaskaCare Employee Health Plan includes a three-tier pharmacy structure featuring different coinsurance and copayments for medications based on drug type:

  • Tier One: Generic Drugs — lowest cost tier

    Generic medications are therapeutically, and often chemically, identical to brand medications and are widely available at competitive prices.

  • Tier Two: Preferred Brand-Name Drugs — slightly higher cost tier.

    Preferred brand drugs are medications for which a generic is either unavailable, or offered at discounted prices.

  • Tier Three: Non-preferred Brand-Name Drugs — highest cost tier.

    Non-preferred brand drugs are medications available in an equivalent generic form, or as a preferred brand drug. These drugs cost more to both the plan and the member, but a lower cost equivalent medication is available.

Members using generic medications may experience a decrease in the cost-share for their prescription. Members using a preferred brand name or non-preferred brand name medication may pay more. Be sure to check the 2018 Aetna Pharmacy Drug Guide and the Exclusion Drug List to see where your prescription is listed. You and your provider can search for a drug, ensure it is not on the exclusion list, and determine if there are lower cost alternatives.

How are drugs assigned to a tier? A tool called a “formulary” is used to assign medications to different tiers. The formulary for the employee plan is the 2018 Aetna Pharmacy Drug Guide. This guide is developed not only with overall value of the medication in mind, but based on drug safety, effectiveness and current use in therapy. Although some medications will no longer be covered (see Exclusion Drug List), the plan still covers the vast majority of prescription drugs, and you are free to choose a generic, preferred brand name or non-preferred brand name medication. Choosing a lower tiered drug when it is appropriate can provide access to the necessary medications to stay healthy, at a cost that is more affordable. Choosing a generic medication means your out-of-pocket cost will be less than if you choose a preferred brand name. Remember the lower the tier, the lower the out-of-pocket costs!

If you choose mail order your copay goes further. Choosing to fill your prescription medications through mail order when appropriate, can save you money. You can receive up to a 90-day supply for one low copayment when using mail order. You can also fill up to a 90-day prescription at a participating retail pharmacy; however, you will pay separate copays for each 30-day supply.

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