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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 Healthcare health plan coverage until the next year unless you have a qualified life event as defined by the IRS.
HAVE A QUESTION?
If you can’t find an answer to your question after reviewing the information on this site, please email HRBenefitsTeam@rsfh.com or call (843) 720-8400.
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 and return the Teammate Enrollment Form that was mailed to you. You can also access the form here: Harness Health Teammate Enrollment Form
- Step 2: 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 3: Allow 5 – 7 business days to receive your medication by mail.
Harness Health Pharmacy is a convenient option for your maintenance medication needs. If you have questions or need assistance, please call them at 866-775-5767 Option 1.
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.
Formulary
For reference, there is a full RSFH Pharmacy Benefits Formulary effective July 2023. It is often easier to navigate referencing the Formulary with the digital Formulary Look Up Tool.
For More Information
Teammates can access MedImpact’s portal for more details, such as prescription drug pricing and network information.