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IMPORTANT: If you do not elect your benefits during the annual Open Enrollment period or within 31 days of your date of hire, you will not have Roper St. Francis health plan coverage until the next year unless you have a qualified life event.
HAVE A QUESTION?
Your Prescription Drug Coverage
MagellanPharmacy is the retail pharmacy benefits administrator for all Roper St. Francis medical plans. Magellan Rx Home will provide mail order services for maintenance brand and non-preferred brand drugs. Your prescription drug plan will correspond with the medical health plan you elect during your enrollment.
You have a choice to fill your generic maintenance medications at a local retail pharmacy (30-day supply) or receive them at home (90-day supply) through Magellan Rx Home Mail Service Pharmacy.
How to use your prescription drug coverage:
- Retail: Present your pharmacy beneﬁt card with your prescription at your local retail pharmacy to automatically receive your beneﬁts. You will pay the applicable co-pay or deductible/coinsurance amount, depending upon the health plan you have selected.
- Have a question? Call 1-800-424-6620.
Mail Order: Refill your medication by choosing one of these options:
- Mail: Complete the refill section on the order form and mail to PO Box 620968 Orlando, FL 32862.
- Phone: Call us at 1-800-424-1771 with your prescription number and payment information.
- Web: Register online at www.magellanrx.com/member, select Members, then Forms and Mail Order. Select the Magellan Rx Home link to edit payments and order refills
Injectables/Specialty: Most injectable, intravenous and specialty medications must be obtained and administered through the St. Francis Pharmacy or the West Ashley Cancer and Infusion Center.
For a complete list of pharmacies and covered medications, please visit www.magellanrx.com/member.
|Alliance Prime||Alliance Flex||Alliance Save||Alliance Out-of-Area|
|Deductible and Out-of-Pocket Limit-Pharmacy|
|Annual Pharmacy Deductible||N/A||N/A||Included in medical deductible||N/A|
|Annual Pharmacy Out-of-Pocket Limit||$1,200 teammate/ $2,400 family||$1,200 teammate/ $2,400 family||Included in medical out-of-pocket maximum||$1,200 teammate/ $2,400 family|
|Using a Retail Pharmacy|
|Generic||$10||$10||You pay 30% after deductible||$10|
|Brand*||$35||$35||You pay 30% after deductible||$35|
|Non-preferred Brand*||You pay 40% ($50 min/ $150 max)||You pay 40% ($50 min/ $150 max)||You pay 30% after deductible||You pay 40% ($50 min/ $150 max)|
|Mail Order (90-day Supply)|
|Generic||$20||$50||You pay 30% after deductible||$20|
|Brand||$87.50||$87.50||You pay 30% after deductible||$87.50|
|Non-preferred Brand||You pay 40% ($125 min/ $375 max)||You pay 40% ($125 min/ $375 max)||You pay 30% after deductible||You pay 40% ($125 min/ $375 max)|
|Specialty Drugs (Injectables)|
|Self-injectables through 4D Pharmacy||$50 (30-day supply)||$50 (30-day supply)||You pay 30% after deductible||$50 (30-day supply)|
|Specialty/Injectable Drugs through West Ashley Cancer & Infusion Center||$50||$50||You pay 30% after deductible||$50|
|Specialty Drugs with Limited Distribution||$150||$150||You pay 30% after deductible||$150|
* You will be able to get your maintenance brand/non-preferred brand drug at a retail pharmacy three times at your regular co-pay/coinsurance. Beginning with the fourth fill obtained at a retail pharmacy, you will pay 100% of the cost of the drug. In order to continue receiving benefits, you must switch to a 90-day prescription and fill through Magellan RX Home.