Prescription Drug Coverage

At Humana, we know that paying for medications can be a challenge. Our prescription plans offer you choices you can make with confidence.

Humana's innovative prescription drug benefits include Rx4, Rx4 + Deductible, and RxImpactSM. For High Deductible Health Plans, prescription drug benefits are integrated with the medical plan.

 

How it works

With Rx4, Rx4 + Deductible, and RxImpactSM, covered drugs are grouped into four levels. With a High Deductible Health Plan, drug costs apply to the same deductible as medical costs.

Rx4

Rx4 puts drugs in one of four levels. The lower the drug's coverage level, the less you pay. Your employer chooses the copayment amounts for your plan.

The levels are:

  • Level One — Low-cost generic and brand-name drugs.
  • Level Two — Higher-cost generic and brand-name drugs.
  • Level Three — Higher-cost brand name drugs. These drugs may have generic or brand-name alternatives on Levels One or Two that may save you money.
  • Level Four — Includes self-administered, injectable medications, and high-technology drugs. These drugs may cost you more than drugs in Levels One, Two, or Three.

How it works example - Rx4

Let's say your copayment amounts are $10 / $25 /$50 / 25% and you fill a prescription for Albuterol, a generic asthma medication. The retail cost for Albuterol is $15.60. Because it's in Level One, you pay a $10 copayment, and the plan picks up the remaining $5.60.

Rx4 with Deductible

Level One drugs, including many generics, are not subject to a deductible and have the lowest copayment. You pay an annual deductible for drugs in Levels Two, Three, and Four combined.

After meeting the deductible, you pay a fixed copayment or percentage for each prescription; the plan pays the rest.

RxImpact

With RxImpact, drugs are placed in four groups according to their ability to prevent a serious medical episode in the immediate future.

  • Humana pays a fixed allowance toward the cost of drugs in each group. Your employer chooses the allowance amounts for your plan.
  • You pay the difference between the allowance and the pharmacy's price, so you can save money by talking to your doctor about lower-priced medications.

The groups are:

Group A — Drugs with the greatest ability to prevent a serious medical episode. This group includes drugs for conditions like asthma, infections, depression, and juvenile diabetes. Drugs to prevent pregnancy are also in this group.

Group B — Drugs for the control of long-term conditions. This group includes drugs that treat cancer, heart disease, and multiple sclerosis.

Group C — Drugs that may reduce symptoms and improve day-to-day functioning. This group includes pain medications and drugs that treat allergies, arthritis, and indigestion.

Group D — Drugs that may improve psychological, emotional, or physical well-being. This group includes drugs for obesity, sexual dysfunction, and acne. Many of these drugs aren't covered by other prescription drug plans.

How it works example — RxImpact

Let's say your allowance amounts are $30 / $20 / $10 / $5 and you take Lisinopril for high blood pressure. The retail cost for Lisinopril is $25.00. It's in group B, which has a $20 allowance. Your plan pays $20 toward the cost of the drug, and you pay the remaining $5.

High Deductible Health Plan

If you have a High Deductible Health Plan (HDHP), your pharmacy benefits are built in to your medical plan. An HDHP has an integrated deductible, which means your out-of-pocket costs for both medical and prescription drugs apply to the same deductible. Once you meet the deductible, the plan pays all or most of your costs for covered medical services and prescription drugs.

The High Deductible Health Plan provides coverage for drugs specifically on the HDHP Drug List. Drugs not covered on the list do not apply toward your deductible, but as a Humana member you can get them at a discounted rate, which may be lower than the retail price.

 

FAQs

Here are some common questions about Humana's Rx4 and RxImpact prescription drug benefits.

How can I reduce my prescription drug costs?

To get the most from your Humana prescription drug benefit:

  • Ask your doctor if a possible lower-cost drug alternative is appropriate for you

  • Use the Pharmacy Locator to find in-network pharmacies, so you can take advantage of reduced prices for Humana members

  • Use Humana's Drug List Search to find estimated retail costs for drugs and view possible alternatives

Can I use mail-order for my prescriptions?

Yes. For most plans, the preferred prescription home-delivery service by mail is RightSource Mail-Order Pharmacy.RightSource Mail-Order Pharmacy works best for maintenance medications - the ones you plan to take for a long time. For immediate needs - such as pain medications, antibiotics, and other short-term medications - it's best to use a local retail pharmacy in Humana's network. Find out more about RightSource Mail-Order Pharmacy.

Are generic drugs as effective as brand-name drugs?

The main difference is the name. A generic drug is usually called by its chemical name, instead of a brand name. Generic drugs meet the same stringent performance and manufacturing standards as brand-name medications and usually cost less. The U.S. Food and Drug Administration (FDA) requires that each generic drug have the same active ingredients, strength, and dosage form as the brand-name version. Generic drugs must also pass the same FDA standards for quality and clinical effectiveness.

For more details, visit Brand vs Generic.

What if my doctor prescribes a brand-name drug?

If your doctor writes on your prescription "dispense as written" (DAW), you can receive only that specific drug, even if a generic equivalent is available. As a result, you'll receive that specific drug, but only will be responsible to pay the appropriate brand-name copayment. In this case, you aren't responsible for the cost difference between the brand and generic medications.

If you use a brand-name prescription drug when a generic drug is available — and your doctor hasn't provided a medical reason for the brand-name drug — you'll be responsible for paying the difference between the brand-name cost and the generic cost plus any applicable generic copayment.

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