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 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.
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.