Prescription Drugs
All medical plans administer prescription drug coverage through CVS Caremark.
Drug Tiers
- Generic: Affordable and effective alternative to a brand name drug, typically the lowest cost option.
- Preferred brand drugs: Typically cost more than generics but less than other brand-name drugs because of their preferred status due to their clinical value and cost-effectiveness.
- Nonpreferred and brand name drugs: Cost more than a preferred brand drug would because of their non-preferred status.
- Specialty: Expensive drugs used to treat complex, chronic or rare medical conditions. Typically, these can only be filled by a specialty pharmacy.
Plan Costs
The cost for prescription drugs depends on the tier of drug and quantity you fill.
All our medical plans offer no-cost programs for specialty, asthma and diabetes medications.
Retail vs. Mail Order
Typically, retail pharmacies are used for filling 30-day prescriptions. However, you may be able to order a 90-day supply of maintenance medications — either at a retail pharmacy or through mail order.
The advantage to using mail order for 90-day prescriptions is convenience—your prescription is delivered to your door with an auto-refill option.
Cost for 30-Day Supply
| Allegiance CDP | Johns Hopkins EPO | Allegiance OAP | Johns Hopkins PPO | |
|---|---|---|---|---|
| Generic | You pay 10% up to $10 | $10 copay | You pay 10% up to $10 | $10 copay |
| Preferred | You pay 20% up to $600 | You pay 25%; min $40, max $60 |
You pay 20% up to $200 | $40 copay |
| Brand & Non-Preferred1 | You pay 40% up to $400 | You pay 50%; min $65, max $105 | You pay 20% up to $200 | $65 copay |
| Specialty | You pay 30%, or $0 if enrolled in PrudentRx | You pay 30%, or $0 if enrolled in PrudentRx | You pay 30%, or $0 if enrolled in PrudentRx | You pay 30%, or $0 if enrolled in PrudentRx |
Cost for 90-Day Supply
| Allegiance CDP | Johns Hopkins EPO | Allegiance OAP | Johns Hopkins PPO | |
|---|---|---|---|---|
| Generic | You pay 10% up to $15 | $30 copay | You pay 10% up to $15 | Retail: $30 copay Mail order: $20 copay |
| Preferred | You pay 20% up to $600 | You pay 25%; min $120, max $180 | You pay 20% up to $600 | Retail: $120 copay Mail order: $80 copay |
| Brand & Non-Preferred1 | You pay 40% up to $1,200 | You pay 50%; min $195, max $315 | You pay 20% up to $600 | Retail: $195 copay Mail order: $130 copay |
| Specialty | Not covered | Not covered | Not covered | Not covered |
- If you choose a brand name drug when there’s a generic alternative, you’ll also pay the cost difference between the two.
Need Help Picking a Medical Plan?
ALEX, your online benefits counselor, can provide personalized recommendations to help you make confident, informed choices.
Utilice ALEX en español. Al empezar su experiencia con ALEX, puede cambiar el idioma a español desde la esquina derecha de arriba.
No-Cost Programs for Specialty, Asthma and Diabetes Medications
The following programs are available with all medical plan options.
No-Pay Copay for Asthma & Diabetes Medications
The No-Pay Copay benefit will waive the copay for most asthma and diabetes medications
if you’re enrolled in the Allegiance Nurse Health Coaching program or the Johns Hopkins Employer Health Program’s (EHP) Care Management program.
In each program, you’ll work one-on-one to:
- Evaluate your wellness and personal needs
- Coordinate your health care
- Improve self-management of your condition
To learn more and enroll, contact:
- Allegiance at 866-458-0474
- EHP at 800-557-6916 or caremanagement@jhhp.org
PrudentRx Specialty Medication Program
You can get certain specialty medications at no cost through the PrudentRx program. Prescriptions must be filled at a CVS Specialty Pharmacy or Publix.
You can view the current list of eligible medications under the PrudentRx program. This list is updated monthly, so please check it regularly for any changes.
You’re automatically enrolled in the PrudentRx program if you take any eligible medications. If you choose to opt out of the program, you’ll pay 30% coinsurance (after the deductible) for your medication. View the FAQs for more information.
Note: If you contributed a certain amount to your health care flexible spending Account (FSA) based on your specialty medication’s eligibility, and the medication is added or dropped from the list, you’ll be allowed to make changes to your health care FSA election.