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(Responses to inquiries are provided 8 a.m. - 5 p.m., Monday-Friday.)

Pharmacy

Your plan options include coverage of prescription drugs. Learn more about how your pharmacy benefits work using the resources below.

Once you’re a member, log in to mymedica.com and you’ll be able to see pharmacy information specific to your benefits, including pricing and ways to save on your prescriptions. 

What Drugs are Covered?

Covered drugs are shown on the Medica drug list. The list includes both brand-name and generic drugs, and is reviewed and updated regularly by a group of independent physicians and pharmacists. Your doctor can use this list to choose medications that are right for you.

» View the drug list.

How Much Will My Prescriptions Cost?

The drug list is divided into three groups, which determine your share of the costs (generic, preferred brand and non-preferred brand). Generic drugs have the lowest copayment or coinsurance.

Learn more about your pharmacy benefits below and in the Plan Options section.

$2,500 Choice with UHC PPO Plan, $2,500 Elect Plan, $2,500 Park Nicollet First Plan, $2,500 VantagePlus Plan

Generic drugs (in-network)
Retail: $10/prescription. Deductible does not apply.
Mail order: $20/ prescription for a three-month supply. Deductible does not apply.

Preferred brand drugs (in-network)
Retail: $35/prescription. Deductible does not apply.
Mail order: $70/ prescription for a three-month supply. Deductible does not apply.

Non-preferred brand drugs (in-network)
Retail: $50/prescription. Deductible does not apply.
Mail order: $100/ prescription for a three-month supply. Deductible does not apply.

Specialty drugs (in-network)
Preferred: 20% coinsurance. No more than $200 copay/prescription. Deductible does not apply.
Non-preferred: 30% coinsurance. Deductible does not apply.

Copay Choice with UHC PPO Plan

Generic drugs (in-network)
Retail: $10/prescription. Deductible does not apply.
Mail order: $20/ prescription for a three-month supply. Deductible does not apply.

Preferred brand drugs (in-network)
Retail: $20/prescription. Deductible does not apply.
Mail order: $40/ prescription for a three-month supply. Deductible does not apply.

Non-preferred brand drugs (in-network)
Retail: $35/prescription. Deductible does not apply.
Mail order: $70/ prescription for a three-month supply. Deductible does not apply.

Specialty drugs (in-network)
Preferred: 20% coinsurance. No more than $200 copay/prescription. Deductible does not apply.
Non-preferred: 30% coinsurance. Deductible does not apply.

How Do I Fill My Prescriptions?

You have access to more than 64,000 pharmacies nationwide - including chain pharmacies (Walgreens, CVS Pharmacy, etc.) and neighborhood pharmacies.

» Find a pharmacy.

Mail Order Program

If you have prescriptions for a long-term condition, getting your drugs through the mail may be a convenient option for you. You’ll receive a 90-day supply of your medication delivered right to your mailbox, with no shipping or handling fees.

You’ll be able to start, manage and refill a mail order prescription with CVS Mail Service Pharmacy starting Jan. 1, 2018. Before starting mail order, we encourage you to do the following:
     • When your plan starts, register on mymedica.com, your Medica member
        portal, for single sign-on access to your prescription and pharmacy resources.
     • Talk with your doctor to make sure it’s OK to order a 90-day supply of your
        medication – mail order drugs can’t be returned.
     • Check pricing at your retail pharmacy. Depending on your benefits, you may
        find it’s less expensive to continue getting your medications at your local
        pharmacy. When your plan starts, you can compare costs using the “Check
        Drug Cost” tool on mymedica.com.

How Do I Get a Specialty Drug?

Some medications are considered specialty drugs. These drugs are used to treat certain complex health problems. Specialty drugs tend to be very expensive and may need special handling. In 2018, you'll fill most specialty prescriptions through Accredo Specialty Pharmacy, Medica’s new preferred specialty drug provider.

If you have questions about specialty drugs, please contact Medica Customer Service at 855-857-2045.

» View the 2018 Specialty Drug List.

Where Can I Find More Pharmacy Resources?

Learn more about your pharmacy benefits including:

What’s the difference between brand-name drugs and generic drugs?
A brand-name drug is protected by a patent for a certain amount of time. That means only one manufacturer can make the drug during that time. Once the patent expires, generic versions of the drug are often introduced.

Generic drugs have the same active ingredients as their brand-name counterpart and must meet the same quality standards as brand-name drugs, but are generally less expensive.

Both brand-name and generic drugs are regulated by the Food and Drug Administration (FDA).

Does the drug list ever change?
Yes. A team of physicians and pharmacists regularly reviews new and existing drugs to be sure the drug list continues to meet the needs of our members and providers. Drugs may be added to the list at any time during the year; however, Medica strives to limit removing drugs to no more than twice a year.

If a generic equivalent becomes available for a brand-name medication on our drug list, we may update the list to only include the generic as the preferred drug. If a change to the list affects a drug you are taking, we’ll send you a letter telling you about the change

What are drug quantity limits?
A quantity limit is a maximum amount of a drug that is allowed to be filled during a specific period of time. For example, 60 tablets per month. Drugs that have a quantity limit are noted on the drug list.

What is a specialty drug?
Specialty drugs are used to treat certain complex health problems. These drugs tend to be very expensive and may need special handling and monitoring. Watch for more information soon about what drugs are considered specialty drugs and how you fill your specialty drugs.

What is Step Therapy?
Step Therapy is a program focused on using cost-effective prescription drugs as first-line treatment when appropriate. The program is used for certain conditions where there are many treatment options available. Drugs that require Step Therapy are noted on the drug list.

In Step Therapy, you try the Step 1 preferred drug or drugs first. Step 1 drugs are cost efficient and effective options. If the Step 1 drug isn’t effective, you can then try the Step 2 drug. In some cases, you may need to try more than one Step 1 drug before trying a Step 2 drug.

Step Therapy applies to all members, regardless of their plan type. That means that if you don’t try the Step 1 drug or drugs first, then a Step 2 drug won’t be covered. Your doctor can request an exception to this process.

What is Prior Authorization?
Prior Authorization is approval given by Medica for coverage of a certain medication. Medications that require Prior Authorization are noted on the drug list with a "PA" next to the drug name. As a provider in the Medica network, your doctor will know how to request Prior Authorization.

What if I need a drug that’s not on the drug list?
Your doctor can request an exception to the drug list by faxing a completed Exception Request Form.

Your doctor should provide all the requested information, including which medications have been tried and didn't work (e.g. dosage information and reason for failure, such as side effects lack of efficacy, etc.).

Can I appeal if an exception request is denied?  
Yes. If your exception request is denied, Medica will send you a letter explaining your right to appeal and the process for the appeal.

Watch for Your New Medica ID Card

Your Medica plan will start on Jan. 1, 2018. You’ll receive your new Medica ID card in the mail by the end of December. Remember to show your new ID card to your doctor and pharmacy after Jan. 1.

Additional Benefits from the City of Saint Paul

The City of Saint Paul offers a variety of non-medical employee benefits.

» Learn more about non-medical employee benefits.