RWJBarnabas Health Prescription Drug Benefits

When you enroll in a medical plan option, you are automatically enrolled in prescription drug coverage through Prime Therapeutics.

You may fill your prescriptions at an in-network retail pharmacy, an RWJBarnabas Health pharmacy (including Walgreens pharmacies that are onsite at an RWJBarnabas Health facility), or through mail order.
CVS is not a participating retail pharmacy so prescriptions filled there will not be covered under the plan.
All mail order and specialty prescriptions will be filled through Livingston Service Corp (LSC), the RWJBarnabas Health mail order pharmacy.

Service	RWJBarnabas Health OMNIA℠ and Direct Access® Plans	High Deductible Health Plan
Deductible	$100 per person per year (applies to Brand and Specialty medications)	Integrated with Medical Deductible
Out-of-Pocket Maximum	Integrated with Medical	Integrated with Medical

Retail (30-Day Supply)

Service	RWJBarnabas Health OMNIA℠ and Direct Access® Plans	High Deductible Health Plan
Generic	$10 copay (no deductible)	$10 copay (after deductible)
Brand Preferred	You pay 20% (after deductible) Minimum: $25; Maximum: $50	You pay 20% (after deductible) Minimum: $25; Maximum: $50
Brand Non-Preferred	You pay 40% (after deductible) Minimum: $50; Maximum: $100	You pay 40% (after deductible) Minimum: $50; Maximum: $100

LSC Mail Order (90-Day Supply of Maintenance Medications)

90-day supply can only be filled at LSC Mail Order, on-site RWJBarnabas Health Pharmacies, or Walgreen Pharmacies that are on-site at RWJBarnabas Health facilities. CVS is not a participating retail pharmacy so prescriptions filled there will not be covered under the plan. You must use mail order after the second fill.

Service	RWJBarnabas Health OMNIA℠ and Direct Access® Plans	High Deductible Health Plan
Generic	$20 copay (no deductible)	$20 copay (after deductible)
Brand Preferred	You pay 20% (after deductible) Minimum: $63; Maximum: $125	You pay 20% (after deductible) Minimum: $63; Maximum: $125
Brand Non-Preferred	You pay 40% (after deductible) Minimum: $125; Maximum: $250	You pay 40% (after deductible) Minimum: $125; Maximum: $250
Specialty Preferred	You pay 25% (after deductible) Minimum $100; Maximum $250	You pay 25% (after deductible) Minimum $100; Maximum $250

Specialty Medication (30-Day Supply) - Available ONLY at LSC

Service	RWJBarnabas Health OMNIA℠ and Direct Access® Plans	High Deductible Health Plan
Specialty Non-Preferred	You pay 40% (after deductible) Minimum $250; Maximum $400	You pay 40% (after deductible) Minimum $250; Maximum $400

IMPORTANT: The HDHP prescription drug benefit is integrated with your medical plan.

This means that your out-of-pocket costs for both medical and prescription drugs apply to the same plan deductible. Members will pay the full discounted cost for scripts until the medical plan deductible is satisfied. After the plan deductible has been met, the plan begins to pay coinsurance until the out-of-pocket maximum has been met.