Prescription Drug Coverage

The Health Tradition formulary

For pharmacy (Catamaran) reimbursement forms, click on the FORMS tab at Mayo Clinic Health Solutions.com

Prescription drug plan

Health Tradition has contracted with Catamaran 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 Catamaran 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-Catamaran 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 Mayo Clinic Health Solutions 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, Premier Plus and Premier One

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 Catamaran 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, Premier One and 65Plus pharmacy directory

To locate the closest participating Catamaran pharmacy, click on the Mayo Clinic Health Solutions Web Site . At the home page, click on My Pharmacy, located in the navigational tool bar. Then click on Pharmacy Search. If you are not registered with Mayo Clinic Health Solutions, you may also contact Customer Service at our toll-free number 877-832-1823 and ask for the Catamaran pharmacy nearest you.

BadgerCare Plus

Health Tradition does not provide pharmacy benefits for BadgerCare Plus members. Please call Member Services at 1-800-362-3002 for assistance.

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How the prescription benefit works

Premier, Premier Plus and Premier One

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.

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Foreign travel and vacations

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.

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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.