Prescription Coverage
Prescription drug expenses are covered under the medical plan as are other expenses related to a covered
sickness or injury. Students enrolled in the Student Medical Plan are automatically enrolled in the drug plan,
administered by 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; 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.
Co-payment Schedule
| Category |
Retail
(30-day supply) |
Mail Order
(90-day supply) |
| OTC (Prilosec, Claritin, Claritin 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) medications 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.
Online prescription benefit cards and direct member reimbursement forms are available.
Envision Rx Options
2181 E. Aurora Rd.
Suite 201
Twinsburg, OH 44087
To locate a network pharmacy, please visit the Envision Rx website 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 determine which category the prescription applies in order to collect the correct co-payment at the time of purchase. Envision Rx customer service representatives are available for assistance as well.
The mail order facility for this plan is Walgreens. In addition to receiving a 90-day supply prescription through the mail, a 90-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 available on the Walgreens website. For long-term medications needed right away, the participant should ask his/her 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 substances 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 two weeks for delivery.
Mail Pharmacy Customer Service:
1.800.992.2655 (TTY 1.800.925.0178)
Monday – Friday: 8 a.m. – 8 p.m. (Eastern)
Saturday: 8 a.m. – Noon (Eastern)
Refills by phone:
1.800.749.0009
Internet:
www.walgreensmail.com