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State Health Benefit Plan Members
WE SHARE YOUR VALUES

Pharmacy Benefits

We want you to find a pharmacy benefit that fits your needs, offers true value to you and your family, and is easy to use and to know.

We want you to get the most from your pharmacy benefit. We have tools to help you and your doctor to choose the right medications for you and save money.

UnitedHealthcare has over 28 years of experience in managing and administering prescription drug programs and a proven track record for providing quality pharmacy benefit management services. Our focus is on providing superior customer service to you and your family. UnitedHealthcare, in partnership with Medco provides pharmacy benefit management services for UnitedHealthcare State Health Benefit Plan.

We share your values and our focus is on providing superior customer service to you and your family.



  • Summary
  • Prescription Drug Costs

2010 Pharmacy Benefits

Online Pharmacy Benefit Tool
Find estimated out-of-pocket costs for prescription medications - Compare costs prescription medications - Identify lower-cost medication alternatives.

Locate a participating retail pharmacy

Please note: We apologize but the changes for the UnitedHealthcare 2010 Prescription Drug Lists for Choice HMO and Choice Plus plans are not available under "Pharmacy Benefit Tool" therefore a few drug tiers and quantity limits listed in the tool will change. Please view the 2010 PDL changes available on this page to help with your prescription drug decisions.

Network Pharmacies
 

Independent Pharmacy ListingChain Pharmacy Listing

For Definity HRA:
 

2010 Pharmacy Benefit Tools2010 Pharmacy Benefit Summary Overview

Please note: The Definity HRA Plan does not have Tiers or a Prescription Drug List

For Choice Plus:
 

2010 Pharmacy Benefit Tools2010 Therapeutic Prescription Drug List (July 1, 2010 addendum)2010 PDL Changes 2010 Pharmacy Benefit Summary OverviewChoice Plus 2010 PDL

For Choice HMO:
 

2010 Pharmacy Benefit Tools2010 Therapeutic Prescription Drug List (July 1, 2010 addendum)2010 PDL Changes2010 Pharmacy Benefit Summary OverviewChoice HMO 2010 PDL

For High Deductible Health Plan (HDHP):
 

2010 Pharmacy Benefit Tools2010 Therapeutic Prescription Drug List (July 1, 2010 addendum)2010 PDL Changes2010 Pharmacy Benefit Summary OverviewHDHP 2010 PDL

For Medicare Direct:
 

For additional information, click here.

Match up your pharmacy benefit to your needs

 Definity HRA
HDHP
Choice HMO Choice Plus
Coverage for majority of Food and Drug Adminstration (FDA) approved prescription medications  X  X X
 X
 Generic medications are the lowest cost option
    Most of the time** see below
 X
 Some brand name medications are the lowest cost option
     X
 
 Prescription Drug List with Tiers
    X X
X
 For certain medications supply limits and benefit rules may apply before buying the prescription
  X X
  X  X
 I pay co-insurance (after the deductible is met)
 X
 X    
 I pay co-payments (do not apply to the deductible)
      X X
 My prescription costs are applied to the deductible
  X X
   
 Copay/Co-insurance Waiver Program
 X
     X
 The SHBP funds dollar credits to your HRA each year for medical and pharmacy expenses
  X      
 I can request my prescription be filled with a brand name medication when a generic is available. I will pay more than my co-insurance or co-payment
  X X
 X  X
 In and out of network benefits (see the Benefit Grid for a or co-insurance amount)
  X      X
** While generics are typically less expensive than the brand name, that may not always be the case, so be sure to check prices on the website to look at all of your options or call customer care.

Definity HRA

Network PharmacyIn-Network
  Co-insurance for up to a 31-day supply for a network pharmacy*
Generic drugs 15% of the prescription drug cost

 
Brand name drugs 25% of the prescription drug cost

 
Non-Network PharmacyOut-of-Network
  Co-insurance for up to a 31-day supply for a network pharmacy*
Generic drugs 40% of the prescription drug cost

 
Brand name drugs 40% of the prescription drug cost

 

*For covered prescriptions purchased at an out-of –network pharmacy or without your ID card please, consult 2010 Prescription Drug Benefit Plan Overview for reimbursements.

High Deductible Health Plan

Network PharmacyIn-Network
  Co-insurance for up to a 31-day supply for a network pharmacy*
Tier 1
 20% ($10 min / $100 max)

 
Tier 2
 20% ($10 min / $100 max)

 
Tier 3
 20% ($10 min / $100 max)

 

*In-Network coverage only; Non-Network Pharmacy not covered

Choice HMO

Network PharmacyIn-Network
  Co-payments for up to a 31-day supply
Tier 1
 $15

 
Tier 2
 $40

 
Tier 3
 $75

 

* Generic drugs may be in Tier 1, Tier 2, and Tier 3.


Choice Plus

Network PharmacyIn-Network and Out-of Network*
  Co-payments for up to a 31-day supply
Tier 1
 $15

 
Tier 2
 $40

 
Tier 3
 $100

 

*For covered prescriptions purchased at an out-of –network pharmacy or without your ID card please, consult 2010 Prescription Drug Benefit Plan Overview for reimbursements.

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