Your Prescription Drug Coverage
MedImpact is the pharmacy benefits administrator for all Roper St. Francis Healthcare medical plans. Your prescription drug plan will correspond with the medical health plan you elect during your enrollment.
All Maintenance drugs (generic and brand) will need to be filled for a 90-day supply through Mail Order, after one retail fill.
How to use your prescription drug coverage
Non-Maintenance Medications: Filling at a Retail Pharmacy
You may get non-maintenance prescription drugs at one of 65,000 MedImpact participating retail pharmacies. Non-maintenance medications are for short-term use, such as an antibiotic or pain medicine. They typically do not have a refill and are dispensed in quantities of 30 days or less.
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.
To find an in-network retail pharmacy near you, sign in to http://www.medimpact.com and use the online Pharmacy Locator tool.
If you have questions, or need assistance, contact Medimpact at (888) 783-1780 (TTY dial 711).
Maintenance Medications: Mandatory Mail Order Through Harness Health
You are permitted one 30-day retail fill of each maintenance medication while you are transitioning to home delivery. Beginning on the second 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 mail order. Some prescription drugs (including Schedule II controlled substances, i.e. ADHD medications) may not be required for home delivery. These prescriptions can be filled at an in-network retail pharmacy or through home delivery. View this Exception List.
Harness Health Pharmacy is Roper St. Francis Healthcare’s home delivery pharmacy for maintenance medications. Maintenance medications are intended for long-term use for conditions like high blood pressure, high cholesterol, or diabetes.
To set up home delivery through Harness Health Pharmacy, take these steps:
- Step 1: Complete the Harness Health Pharmacy Enrollment Form.
- Step 2: Call the Harness Health Pharmacy team at 866-775-5767 to finalize enrollment with payment, shipping, and communication preferences.
- Step 3: Ask your physician to set up a new prescription for a 90-day supply of your medication—plus refills of up to one year, if appropriate. E-prescribe to “Harness Health – Home Delivery, Store 330” using MyChart, or by calling 866-775-5767 Option 1.
- Step 4: Allow 5 – 7 business days to receive your medication by mail.
Harness Health Pharmacy is a convenient option for your maintenance medication needs. You can manage your pharmacy account 24/7 through the Harness Health Rx mobile app.
- Set up text refill and dose reminders, request refills, see fill history.
- Manage auto-refill medications in advance, ensuring you never run out of medication.
Specialty Pharmacy Services
If you take a specialty medicine(s), the Harness Health Specialty Pharmacy program can help. These drugs treat chronic conditions such as cancer or hepatitis C. If you are taking a specialty medication, please contact Harness Health Specialty Pharmacy, Store 331, at 866-775-5767 Option 2, to help with a smooth transition.
Your medication can be delivered to your home, prescriber’s office, or place of your choice. You can visit Specialty Pharmacy Services | Harness Health Partners (harnesshp.com) to find a complete list of covered medications.
| 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 (30-Day Supply)* | ||||
| Generic | $10 | $10 | You pay 30% after deductible | $10 |
| Non-Preferred Generic | $20 | $20 | You pay 30% after deductible | $20 |
| 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 | $20 | You pay 30% after deductible | $20 |
| Non-Preferred Generic | $40 | $40 | You pay 30% after deductible | $40 |
| 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 (30-Day Supply) | ||||
| Preferred Specialty Drugs | $50 | $50 | You pay 30% after deductible | $50 |
| Non-Preferred Specialty Drugs | $100 | $100 | You pay 30% after deductible | $100 |
Weight Loss Medications
Many employers are excluding expensive weight loss medications. RSFH continues to cover this class of drug; however, weight loss medications like Wegovy and Saxenda continue to be case managed by RSFH’s bariatric specialists, and the prior authorization requirements for new starts for these medications are being further restricted. These drugs will only be available through Harness Health mail order pharmacy in 2024, and a 40 percent coinsurance will apply which will not be applied to the plan’s deductible or out of pocket maximum.
For More Information
Teammates can access MedImpact’s portal for more details, such as prescription drug pricing, network information, the Formulary Lookup tool and a current print version of the Formulary.