Prescription Drug Programs

Participants in HealthSelect^SM health plans are automatically enrolled in a comprehensive prescription drug program. Each plan, except Consumer Directed HealthSelect^SM, has a $50 annual prescription drug deductible that must be paid before the plan pays anything for prescriptions. The annual deductible for Consumer Directed HealthSelect is higher and applies to both medical care and prescription drugs. The deductibles are based on a calendar year, which is from January 1 to December 31.

The following copayments apply to all prescription drug programs, after the deductible is met.

Short-term prescriptions

	Tier 1	Tier 2*	Tier 3*
Non-maintenance medication	$10 1-30 day supply	$35 1-30 day supply	$60 1-30 day supply
Maintenance medication	$10 1-30 day supply	$45 1-30 day supply	$75 1-30 day supply

Long-term prescriptions

Fill long-term medications, also known as maintenance medications, through the pharmacy network(s) for your plan:

• HealthSelect^SM Prescription Drug Program (Non-Medicare): Express Scripts Extended Days’ Supply (EDS) pharmacies or Express Scripts Home Delivery
• HealthSelect^SM Medicare Rx: Express Scripts Medicare (PDP) (mail order service)

Tier 1	Tier 2*	Tier 3*
$20 31-60 day supply $30 61-90 day supply	$70 31-60 day supply  $105 61-90 day supply	$120 31-60 day supply  $180 61-90 day supply

*If a generic is available and you choose to buy the brand-name drug, you will pay the generic copay plus the cost difference between the brand-name and the generic drug.

For more information

Visit your plan's website below for more details about your prescription drug coverage.

HealthSelect of Texas Prescription Drug Program for people enrolled in:

• HealthSelect of Texas (non-Medicare)
• Consumer Directed HealthSelect
• HealthSelect Out-of-State

HealthSelect Medicare Rx for people enrolled in:

• HealthSelect Medicare Advantage Plan, a preferred provider organization
• HealthSelect Secondary