The university provides a prescription drug plan for faculty, staff, graduate students, and retirees who are enrolled in a U-M Health Plan. 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. Prime Therapeutics provides member and pharmacy network services. 

View the prescription drug plan formulary for a list of generic, brand and specialty drugs that are covered by the plan. Specialty drugs are medications that require special handling, special administration or monitoring. Specialty drugs on the formulary are covered when filled at University of Michigan Specialty Pharmacy, even if your doctor is not part of Michigan Medicine.

See News and Updates for announcements and drug plan changes.

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 Prime Therapeutics 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

All health plans except the consumer-directed health plan (CDHP) have no annual deductible for the Prescription Drug Plan. Copays are divided into tiers with different copay levels. Prescriptions must be filled at a pharmacy within the Prime Therapeutics pharmacy network, which includes mail order and the U-M Specialty Pharmacy.

• Tier 0 – Preferred Insulins and Affordable Care Act Preventative Products – zero copay
• 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 with a prescription from your health care provider, including for over-the-counter products. See Coverage and Drug Information for details on the drug plan tiers.

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 product selection penalties 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. For convenience and possible copay savings, use mail order for eligible prescriptions.
2. Use the Prime Therapeutics member portal to find the lowest-cost option for your medications, view your Rx history and find a pharmacy near you. Register now (you will need your ID number).
3. Refer your prescriber to the U-M Prescription Drug Plan formulary for covered generic, brand and specialty drugs.
4. Request generics in a 90-day supply whenever possible, as this can reduce the costs of your medication.
5. Certain preventive products are covered by the prescription drug plan at $0 copay under the Affordable Care Act with a written prescription from your health care provider, including for over-the-counter (OTC) products.
6. Consider participating in a free or discounted prescription program such as those offered through retail pharmacy chains. You will still need to have a prescription and present your U-M Prescription Drug Plan card.
7. 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 Prime Therapeutics

• Online: primetherapeutics.com (register with member ID number at first use). Review the member portal guide for helpful information.
• View prescription drug history, view the formulary, check prior authorization status
• Access the Pharmacy Locator and Drug Price Check

Phone: (888) 272-1346 

Prescriber Fax: (800) 424-7648  

Contact Birdi Mail Order Pharmacy

Online: umich.BirdiRx.com

Phone: (877) 269-1160

Disclaimer

Please be advised that the University of Michigan Prescription Drug Plan formulary is updated periodically and changes may appear prior to their effective date to allow for client notification. The University of Michigan does not warrant or assure accuracy of such information nor is it intended to be comprehensive in nature. The medical provider should consult the drug manufacturer's product literature or standard references for more detailed information. Every effort is made to ensure complete and accurate information; however, the most accurate source of medication coverage and member cost is the Prime Therapeutics online pricing tool. The pricing tool will not provide cost estimates for the product selection penalty or medications that require prior authorization.