15 of 33 Before You Go How You Pay for Care Special Programs and Services Learn More Paying for Prescription Drugs Prescription drug coverage helps pay for prescription medications purchased from 1,700+ Company-owned pharmacies or a participating network pharmacy. MedImpact is the pharmacy benefit manager for the PPO Plan. Important: Your prescriptions will only be covered if you fill them at: • A Company-owned pharmacy (a pharmacy at a store that’s owned by Albertsons Companies) • A pharmacy that is in MedImpact’s network and located more than 10 miles away from a Company-owned pharmacy All Company-owned pharmacies are staffed with highly trained pharmacists and pharmacy technicians who treat your health with care and confidentiality. If you need help with finding a covered pharmacy, please contact MedImpact at 888-402-1984. Your Share of Prescription Drug Costs For Specified Preventive Drugs (see “100%-Paid Prescription Drugs” on next page), you pay $0, and your cost for Generic drugs is a $10 copay (Retail) or $30 copay (Mail Order). You pay coinsurance amounts for Brand Preferred and Brand Non-Preferred prescription drugs, and you do not need to meet the medical deductible in order for your pharmacy benefits to begin cost-sharing. The following table clarifies your share of the cost of prescription drugs. Your Share of the Cost for Prescription Drugs At-a-Glance (See “Things to Consider” on the next page for more information) Before and after you reach your medical deductible: After you reach the out-of-pocket maximum: Specified Preventive Drugs: You pay $0 Specified Preventive Drugs: You pay $0 Generic: You pay a $10 copay Generic: You pay a $10 copay Brand Preferred: You pay 20% (min $30, max $90) of network negotiated cost Brand Preferred: You pay $0 Brand Non-Preferred: You pay 30% (min $60, max $120) of network negotiated cost Brand Non-Preferred: You pay $0
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