Retiree Prescription Coverage
Retirees and/or retiree dependents who are participating in the Medicare Advantage Freedom Blue PPO plan through Highmark, can continue to utilize University Health Services (UHS) for their pharmacy needs or utilize an in-network pharmacy to fill their prescriptions under Express Scripts/Accredo. You can price your medications and verify if your pharmacy is in-network by logging in to your Highmark portal or by calling Highmark Freedom Blue at (866) 918-5285 for current members, or (866) 456-7739 for non-members getting ready to join Freedom Blue.
Retirees and/or retiree dependents who are participating in the Retiree Lion Traditional or Retiree Lion Advantage plans can continue to utilize University Health Services (UHS) for their pharmacy needs or utilize an in-network pharmacy to fill their prescriptions through CVS Caremark. Specialty medications will be administered by CVS Specialty and PrudentRx. You can price your medications and verify if your pharmacy is in-network by logging in to your CVS Caremark portal or by calling CVS Caremark at (833) 298-7175.
CVS Specialty PrudentRx Program
Lion Traditional Participants Only – select specialty medication.
For participants in the Lion Traditional plan, CVS Specialty works with PrudentRx to utilize a voluntary copay assistance program, called PrudentRx, to help reduce the cost of select high-priced specialty medications.
PrudentRx helps to leverage manufacturer assistance dollars to lower your out-of-pocket specialty prescription costs. Upon enrollment in the Lion Traditional medical plan, participants should expect to receive a welcome letter in the mail as well as a phone call from PrudentRx regarding enrollment in the program if utilizing one of the specialty medications on the PrudentRx Specialty Drug Formulary.
Other Copay Assistance Programs
There may be opportunities for you to pay lower out-of-pocket costs on select medications at retail pharmacies, including UHS. In many cases, your out-of-pocket costs will be the lowest through the drug plan. We encourage Penn State members to be educated consumers and if you can find a lower cost option to utilize that benefit to supplement the insurance provided through Highmark (Medicare-eligible retirees/dependents) or CVS Caremark (Non-Medicare eligible retirees/dependents) today.
Option 1: Use a drug discount card. Vendors such as GoodRx partner with retail pharmacies to offer lower prices for brand and generic drugs. There are many options available, which can be found via Google. Any pharmacy claims that use a drug discount card do NOT go through the prescription plan and therefore will NOT accumulate towards your deductible, if applicable, or out-of-pocket maximum.
Option 2: Use a copay assistance program (i.e. a copay card) provided by the drug manufacturer for a Brand drug. These dollars are separate funds allocated by the manufacturer to promote brand loyalty and can be used in addition to your prescription plan benefits. The easiest place to find more information is by going to the website for your drug (use Google if needed). Please note that only the amount that you actually pay will count towards your out-of-pocket maximum.
Pharmacy Benefit Contacts and Forms
University Health Services (UHS) | 814-865-4847 | UHS Mail Order Form | UHS Pharmacy Services for Retirees
Highmark Concierge Team | 844-945-5509 | Express Scripts Mail Order Form
Retiree Prescription Costs
| Drug Brands | Retail Pharmacy (30-day supply) | Mail Order | Specialty |
|---|---|---|---|
| ACA Preventive Drugs | 0% | 0% | n/a |
| Preventive Drug List (no deductible, coinsurance only) | 10% | 20% | 40% |
| Generic | 10% | 10% | |
| Preferred Brand Drugs | 20% | 20% | 20%; $65 minimum |
| Non-Preferred Brand Drugs | 40% | 40% | 40%; $100 minimum |
Out of Pocket Maximum - Integrated with Retiree Lion Advantage deductible
| Drug Brands | Retail Pharmacy (30-day supply) | Mail Order | Specialty |
|---|---|---|---|
| ACA Preventive Drugs | 0% | 0% | n/a |
| Preventive Drug List (lower coinsurance) | 10% | 20% | 40% |
| Generic | 50% | 20% | |
| Preferred Brand Drugs | 50% | 20% | 50%; $100 maximum |
| Non-Preferred Brand Drugs | 70% | 40% | 70%; $200 maximum |
Out of Pocket Maximum - $2,000 (Individual Coverage) | $8,000 (Family Coverage)
| Drug Brands | Retail Pharmacy (30-day supply) | Mail Order |
|---|---|---|
| Generic (tier 1 and 2) | $12 copay | $24 copay |
| Preferred Brand Drugs (tier 3) | $35 copay | $40 copay |
| Non-Preferred Brand Drugs (tier 4) | $65 copay | $100 copay |
| Specialty (limited to 31 day supply; tier 5) | $65 copay | $65 copay |
Catastrophic Coverage Period (After $8k member out of pocket costs) - There is $0 member cost sharing for covered Part D drugs in the catastrophic coverage phase.