Prescription Drug Plan

The university provides a prescription drug plan for eligible faculty, staff, graduate students, and retirees. The plan provides prescription drug coverage for outpatient medication needs through a nationwide network of retail pharmacies. The plan also offers a convenient mail order service with reduced copays for maintenance medications. MedImpact Healthcare Systems, Inc. provides member and pharmacy network services.

View the prescription drug plan formulary for a list of generic and brand name drugs that are covered by the plan. Use the preferred drug list to pay a lower copay for certain brand name drugs.

Enrollment

  • When you enroll in a university health plan, you will automatically be enrolled in the prescription drug plan at the same time, with coverage effective on your service date.
  • The prescription drug plan covers the same people as your health plan.
  • You cannot elect prescription drug coverage without health coverage, or vice versa.
  • You will get an ID card from MedImpact in the mail several weeks after enrolling. Your member ID number, shown on the front of the card, will be the letter “U” followed by your U-M employee ID number.

Summary of Coverage

There is no annual deductible for the prescription drug plan. Copays are divided into three tiers. Prescriptions must be filled at a pharmacy within the MedImpact pharmacy network, which includes mail order and the U-M Specialty Pharmacy.

  • Tier 1 – Generic Drugs – low copay
  • Tier 2 – Preferred Brand Name Drugs – intermediate copay
  • Tier 3 – Non-Preferred Brand Name Drugs – high copay, plus possible product selection penalty

Certain medications and supplements are also available at $0 copay under the Affordable Care Act.

Costs and Copays - Tier 1 - Generic
Quantity Active Employees, U-M Retirees MNA Trades
Up to a 34-day supply $10 $7 $5
35-day to 60-day supply $20 $14 $10
61-day to 90-day supply $30 $21 $15
Best Value - Up to 90-day supply through U-M's mail order pharmacy $20 $14 $10
Costs and Copays - Tier 2 - Preferred Brand
Quantity Active Employees, U-M Retirees MNA, Trades
Up to a 34-day supply $20 $15
35-day to 60-day supply $40 $30
61-day to 90-day supply $60 $45
Best Value - Up to 90-day supply through U-M's mail order pharmacy $40 $30
Costs and Copays - Tier 3 - None-Preferred Brand
Quantity Active Employees, U-M Retirees, Trades MNA
Up to a 34-day supply $45 $30
35-day to 60-day supply $90 $60
61-day to 90-day supply $135 $90
Best Value - Up to 90-day supply through U-M's mail order pharmacy $90 $60

Notes:

  1. If the retail price of a covered medication is less than the tier copay, you pay only the cost of the medication. If the cost of the covered medication is more than the copay, you pay only the copay. The member always pays the full cost for prescriptions that are not covered by the plan.
  2. Catastrophic coverage for prescription drugs goes into effect after the annual out-of-pocket maximum of $2,500 per individual coverage or $5,000 per family per year is met. Catastrophic coverage applies only to covered prescription drugs and does not include infertility medications, product selection penalty, or health plan expenses such as physician office visits.
  3. Copays for union members may differ based on their collective bargaining agreement.

Product Selection Penalty

If you or your physician requests a brand-name product when an FDA-approved generic is available, you will be required to pay a product selection penalty, which is the cost difference between the generic and brand-name medication. The product selection penalty is charged in addition to the brand-name (Tier 2 or Tier 3) copay.

Your pharmacist will dispense generic drugs whenever they are available and legally permitted, unless your physician specifies “dispense as written” (DAW) on your prescription or you request the brand name product.

How to Save Money on Prescriptions

  1. Request generics whenever possible to pay the lowest copay.
  2. Use the preferred drug list to pay a lower copay on brand name drugs.
  3. Use mail order for eligible prescriptions to save 1/3 of the copay cost.
  4. Participate in the Statin pill-splitting incentive program if you take a statin cholesterol-lowering medication to save 1/2 of the copay cost.
  5. Participate in a Health Care Flexible Spending Account (FSA) to use pre-tax dollars for prescription copays and many over-the-counter medications (with a written prescription).

Contact MedImpact

Online:

  • Members (register with member ID number at first use)
    • View prescription drug history, view the formulary, check prior authorization status
    • View the Pharmacy Locator and Drug Price Check

Phone: (800) 681-9578

Fax: (858) 790-7100

Contact NoviXus Mail Order Pharmacy

Online: umich.novixus.com

Phone: (877) 269-1160