Prescription Coverage
Prescription drug expenses are covered under the medical plan the same as other expenses related to a covered
sickness or injury. Students enrolled in the Student Medical Plan are automatically enrolled in the drug plan,
administered through Envision Rx Options.
The plan includes a co-payment that is required to be paid when a prescription is purchased. Participants will
pay their predetermined co-payment and the plan will pay the remainder of the cost. The Plan will pay up
to $5,000 under the co-payment schedule. Once the Plan has paid $5,000 under the co-payment schedule,
60% of eligible charges are paid for by The Plan, and the remaining 40% of charges are the responsibility of the
student. Prescription reimbursement paid by The Plan in excess of $5,000 will be applied toward the Plan
Year maximum of $250,000.
Copayment Schedule
| Category |
Retail
(30-day supply) |
Mail Order
(90-day Supply) |
| OTC (Prilosec, Claritin, Claritan D, Loratadine, Loratadine D)* |
$5.00 |
$15.00 |
| Generic |
$15.00 |
$30.00 |
| Brand |
$30.00 |
$60.00 |
| Non-Formulary |
20% with $50 minimum |
20% with $100 minimum |
Certain over the counter (OTC) medication are available. Participants are encouraged to consult their
physician to determine if OTC Prilosec, OTC Claritin, OTC Claritin D, OTC Loratadine or OTC
Loratadine D therapy is appropriate. If it is so determined, the participant’s physician must write a
prescription specifically for one of these medications and present it to the pharmacist to be eligible for
reimbursement under the Plan.
In some cases, it may be necessary to pay the entire cost of the prescription and submit a claim form along
with a pharmacy receipt to Envision Rx Options when a network pharmacy is used.
Prescription benefit cards and direct member reimbursement forms are located on the Student Affairs website.
Address: Envision Rx Options
2181 E. Aurora Rd.
Suite 201
Twinsburg, OH 44087
To locate a network pharmacy, please visit the pharmacy locator or call 800.361.4542 for any customer service-related issue. Please note that no prescriptions will be paid for at non-network pharmacies. The
participant may be required to show his/her Envision Rx ID card at the point of purchase. The pharmacist
will be able to determine to which category the prescription applies in order to collect the correct copayment
at the time of purchase. Envision Rx Options customer service representatives are available to help
in this determination as well.
The mail order facility for this plan is Walgreens. In addition to receiving a ninety-day supply prescription
through the mail, a ninety-day supply may be obtained with a properly written prescription from the
participant's physician by visiting any Walgreens retail location.
Mail Order
New prescriptions must be mailed to the mail service pharmacy or faxed from the participant's physician office
on the Walgreens Healthcare Plus physician fax form. The form is also available on the Walgreens website. For
long-term medications the participant needs right away: ask the physician for two prescriptions – one for a
small supply to fill at a participating retail pharmacy and one for a long-term supply to fill through the mail.
Most orders are shipped by the U.S. Postal Service. Controlled substance may require a signature upon receipt.
Packaging does not show any indication that medications are enclosed. Include payment if applicable to avoid
any delays. Do not send cash. Make check payable to Walgreens Healthcare Plus. Credit cards are accepted.
Allow 2 weeks for delivery.
Mail Pharmacy Customer Service:
1-800-992-2655 (TTY 1-800-925-0178)
Monday – Friday 8:00 a.m. – 8:00 p.m. (Eastern)
Saturday 8:00 a.m. – Noon (Eastern)
Refills by phone:
1-800- 749-0009
Internet:
www.walgreensmail.com