How your prescription benefit works
For covered prescription drugs, you pay a single copayment (or coinsurance percentage) for up to a 34-day supply, excluding diabetic supplies. Coverage for various types of drugs are shown in your Summary of Benefits and Coverage (SBC). Find yours:
The Health Tradition formulary
The formulary is a list of prescription drugs covered by a health plan, showing the cost-sharing categories for each of four drug types.
- Generic—less expensive than brand name
- Brand name—often newer and more expensive than generic
- Non-formulary—drugs not in the Health Tradition formulary which may have coverage depending on the plan
- Specialty drugs—used to treat complex or chronic conditions, including self-administered injectables
Discuss options with your doctor and save money
Generic drugs generally cost less, so ask your doctor if there is a generic alternative. If you choose a brand name drug when a generic equivalent is available, you would pay the generic copayment plus the difference in price between the brand name and generic drug.
Prices can vary widely from one pharmacy to another. It pays to shop, especially if you are on a maintenance (long term) medication. Mail order is often a good option.
- Login to the Mayo Clinic Health Solutions Online Service Center for mail order information.
- Go to WebMD/Rx or GoodRx to compare prices at pharmacies near you and download discount coupons.
- Learn more by watching the video Health Insurance 101: Managing Medications
Health Tradition has a large pharmacy network
Fill prescriptions conveniently in your community or across the country, with the same copayment (or coinsurance) amount.
The network includes Mayo Clinic Health System pharmacies, pharmacies in the OptumRX national network, many national chains and independent pharmacies. Mail order is also available. To locate the closest participating pharmacy,
- Show your membership card to your pharmacist to verify whether the pharmacy participates
- Login to Mayo Clinic Health Solutions Online Service Center to locate the nearest pharmacy
- Call Customer Service at 877-832-1823
Emergency prescriptions from a non-network pharmacy
You would only receive benefits in an emergency situation. To receive reimbursement for an emergency prescription, please contact Customer Service or print the reimbursement form directly from Mayo Clinic Health Solutions Online Service Center. It’s in the “Forms” tab, under “Pharmacy.” Mail the form to Health Tradition with a note of explanation regarding the emergency and why an out-of-network pharmacy was used.
Foreign travel and vacations
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. Check with Customer Service for answers to specific questions.
Coordination of benefits
For members who have dual (two or more) insurance policies, Health Tradition does not offer coordination of benefits for prescriptions. You must choose one of the policy prescription benefits available to you.
- Health Tradition Health Plan Specialty Drug Requirement
- For questions about your pharmacy benefits, please contact Customer Service toll free at 877-832-1823.