Prescription Drug Coverage
Prescription drug coverage for you and your covered dependents is included with the ECU Health Medical Plan. MedImpact administers the prescription drug benefit for all ECU Health Medical Plan participants. If you enroll in one of the medical plans, your prescription drug coverage is provided.
When you or a covered family member need a prescription filled, you may use your medical ID card at the ECU Health Employee Pharmacy or a retail pharmacy that participates in the pharmacy network. You pay a share of the cost of your prescription in the form of a copay or coinsurance. The amount you pay depends on whether you receive a generic, preferred brand or non-preferred brand name drug and which pharmacy you choose. Questions about ECU Health prescription drug benefits? Contact MedImpact at 844‑513‑6009 or www.medimpact.com.
ECU Health Pharmacy Plan
| Medical Savings Plan | Basic and Choice | |||
|---|---|---|---|---|
| Pharmacy | ECU Health Pharmacy | Retail Pharmacy | ECU Health Pharmacy | Retail Pharmacy |
| Rx Deductible | Included w/medical | Included w/medical | None | None |
| Rx Max OOP (Single/Family) | Included w/medical | Included w/medical | $2,500/$5,000 | $2,500/$5,000 |
| Generic (30 days) | Ded., then 10% coins. | Ded., then 20% coins. | $10 copay | $25 copay |
| Preferred Brand (30 days) | Ded., then 20% coins. | Ded., then 30% coins. | $25 copay | $50 copay |
| Non-Preferred Brand (30 days) | Ded., then 30% coins. | Ded., then 40% coins. | $50 copay | $100 copay |
| Generic (90 days) | Ded., then 10% coins. | Ded., then 20% coins. | $30 copay | $75 copay |
| Preferred Brand (90 days) | Ded., then 20% coins. | Ded., then 30% coins. | $75 copay | $150 copay |
| Non-Preferred Brand (90 days) | Ded., then 30% coins. | Ded., then 40% coins. | $150 copay | $300 copay |
| Preferred Brand Specialty Rx | Ded., then 20% coins. | No coverage | $100 copay | No coverage |
| Non-Preferred Specialty Rx | Ded., then 30% coins. | No coverage | $300 copay | No coverage |
| If cost exceeds $300 for all tiers and number of day supply | N/A | N/A | 15% coins. | 25% coins. |
Once a covered family member meets the individual out-of-pocket maximum, the plan will pay the full cost of covered charges for that family member. Charges for all covered family members will continue to count toward the family out-of-pocket maximum. The annual out-of-pocket maximum includes amounts paid toward your deductible.
We will no longer cover free medication for chronic conditions other than ACA required categories and diabetes. ACA required categories include Hyperlipidemia and smoking cessation. The plan will continue to waive copays for diabetes prescriptions filled from the Employee Pharmacy if you participate in coaching to treat and manage diabetes as part of the ECU Health Wellness or MedCost Care Management programs.
New for 2023
If you take chronic/maintenance medications, you will be able to get a 90-day prescription at the Employee Pharmacy for the equivalent cost of 2.5 rather than 3 full copays.
ECU Health provides a fertility benefit for medications, with a maximum lifetime limit of $10,000
