Pharmacy
If you elect the Standard or Enhanced medical plan, you have the option to choose between two prescription
drug plans: the Standard and the Enhanced plan. The Limited prescription plan is only available with the
Limited medical plan.
Employees who work 20-29 hours/ week can only select the Standard Medical Plan with a Standard Rx
prescription plan.
Signature Network
Our Signature Network has approximately 35,000 retail locations available nationwide including approximately
10,000 independent pharmacies. It is a CVS-centric network that allows significant cost savings on your medications.
Even More Savings with Mail Order
If you take prescriptions on an ongoing basis, you may be able to save money with mail order drugs. When you
order through Maxor Plus (MXP) at 800-687-8629 or maxorplus.com, you can get a 90-day supply for the cost of a
60-day supply.
Price a Prescription
Check hometownhealth.com, Price a RX, to compare out-of-pocket expenses between pharmacies.
Choice of Prescription Option
with Standard and Enhanced Medical Plans
Applies to Limited Plan Only
Standard Rx Enhanced Rx Limited Prescription
Retail/Mail Order
Supply 30/90 days 30/90 days 30/90 days
Formulary Generic $15 copay $10 copay $15 copay
$50 brand and
non-formulary $50 brand and
non-formulary N/A
Formulary
Brand Name $40 after deductible $30 after deductible discount only
Non-Formulary $50 or 50% if greater
(ded. applies) $50 or 50% if greater
(ded. applies) discount only
$30 copay $20 copay $30 copay
Mail Order —
Formulary Brand $80 after deductible $60 after deductible discount only
Special
Pharmaceuticals 20% 20% discount only
Separate Prescription
Deductible
Mail Order —
Formulary Generic
The information presented above is a brief pharmacy plan comparison. For more information, please refer to the summary of benefits for each plan
located on Inside Renown under Benefits.
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