Drugs/Pharmacy
Prescription Drug Plan
Health Tradition has contracted with SXC effective July 1, 2005 to provide you with a national network of pharmacies. This allows you to
obtain prescriptions conveniently in your community, or across the
country, for the same copayment amount. Simply present your membership
card to your pharmacist to verify whether the pharmacy participates in
the SXC network. If you have questions about whether a
specific pharmacy is in the network, please review our Network Pharmacy
Directory above, or call Customer Service toll-free at 1-877-832-1823.
If you receive a prescription from a non-SXC pharmacy, you will only
receive benefits in an emergency situation. To receive a reimbursement,
please contact Customer Service and they will send you a reimbursement form,
or you can print the form directly from the MMSI Services Website.
You will find it under the FORMS tab, under Pharmacy. You will need to mail this to Health Tradition
with a note of explanation regarding the emergency and why an out-of-network pharmacy was used.
Your prescription drug plan is based on the Health Tradition Formulary  . The formulary is a list of Health Tradition-approved
drugs that your health plan will cover. Health Tradition reserves the right to change the formulary at any time.
Premier and Premier Plus
If you have a prescription for a drug on the Health Tradition Formulary
that is covered under your plan benefits, you pay either the generic or
brand name copayment amount. If a drug is not listed on the formulary or
not covered under the plan, you either will be responsible for the larger
non-formulary copayment or the entire cost of the medication, depending on
your plan. Please review your Summary of Benefit information that outlines
member responsibility amounts under your employer’s benefit.
65Plus
No outpatient prescription drug benefits will be available under 65Plus policies issued
January 1, 2006, or later. 65Plus does not cover prescription medication, insulin, and
supplies associated with the injection of insulin as 65Plus is prohibited from duplicating
coverage available under the Medicare Part D prescription drug plan.
65Plus policies issued prior to January 1, 2006, for individuals who do not enroll in a
Medicare Part D prescription drug plan, cover prescription medication, insulin, and supplies
associated with the injection of insulin. The Plan pays 80 percent of the cost for
prescription drugs after an annual deductible of $6250 has been met. This deductible does
not apply to insulin. The 65Plus membership card may entitle you to drug discounts at SXC
pharmacies while also tracking how close you are toward meeting the $6250 deductible. There
is no set rate of discount; it varies per prescription drug and per pharmacy.
Premier, Premier Plus and 65Plus Pharmacy Directory
Health Tradition has provided a list of the SXC pharmacies in the immediate service area. Click on the
link below to see if your pharmacy is participating in the SXC network. If you are out of the service area,
please contact customer service at our toll-free number 877-832-1823 and ask for the SXC pharmacy nearest you.
Health Tradition SXC Pharmacy Network Providers
BadgerCare Plus
Health Tradition does not provide pharmacy benefits for BadgerCare Plus members as of 2/1/08.
Please see BadgerCare Plus Pharmacy for assistance.
How The Prescription Benefit Works
Premier and Premier Plus
You pay a single copayment for up to a 34-day supply, excluding diabetic
supplies. You may receive a generic drug or a brand name drug without a
generic equivalent for a single copayment. The generic copayment generally
is a lower amount than the brand name copayment. If you receive a brand
name drug when a generic equivalent is available, you pay the generic
copayment plus the difference in price between the brand
name and generic drug. Health Tradition encourages you to discuss your
prescription options with your healthcare provider. Please refer to your
Summary of Benefits for exact copayment amounts.
Foreign Travel/Vacation
For questions on prescription coverage while on vacation, please contact
Customer Service toll-free at 1-877-832-1823. Coverage is limited and
restrictions apply. Reimbursement for prescriptions purchased outside
the United States is subject to approved status with the United States Food and Drug Administration. For more information on your pharmacy
benefits, please contact Customer Service toll free at 1-877-832-1823.
Coordination of Benefits
For members who have dual (two or more) insurance policies, Health Tradition
does not offer coordination of benefit for prescriptions. You must choose
one of the policy prescription benefits available to you.
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