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 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:
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.
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.
With RxImpact, drugs are placed in four groups according to their ability to prevent a serious medical episode in the immediate future.
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.
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.
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.
Here are some common questions about Humana's Rx4 and RxImpact prescription drug benefits.
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
Yes. For most plans, the preferred prescription mail delivery service is Humana Pharmacy®. Mail delivery 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.
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.
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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