Prescription Drug Benefits
All medical plan participants have prescription drug coverage based on their selected plan. A way to save money is by requesting generics and/or mail order options when available.
HDHP-HSA Plan
| HDHP-HSA Plan | ||
|---|---|---|
| Retail Pharmacy Coverage (01-30 Day Supply) | In Network Pharmacy | |
| Generic | 20% Co-insurance | |
| Preferred Brand | 20% Co-insurance | |
| Non-Preferred Brand | 20% Co-insurance | |
| Retail Pharmacy Coverage (01-90 Day Supply) | In Network Pharmacy | |
| Maintenance Generic | 20% Co-insurance | |
| Maintenance Preferred Brand Medications | 20% Co-insurance | |
| Maintenance Non-Preferred Brand Medications | 20% Co-insurance | |
| Mail Order Extended Supply (01-90 Day Supply) | In Network Pharmacy | |
| Generic | 20% Co-insurance | |
| Preferred Brand | 20% Co-insurance | |
| Non-Preferred Brand | 20% Co-insurance | |
| Accumulations | ||
| Deductible Embedded | $3,500.00 individual / $7,000.00 family | |
| Maximum Out of Pocket Embedded | $5,000.00 individual / $10,000.00 family | |
| Calendar Year Deductible Notes | The calendar year Deductible applies to pharmacy and medical claims. Each individual family member must meet the individual Deductible unless the family Deductible has been met by any two or more covered family members. Once met, your covered prescriptions are subject to the copays above. Generic Dispense as Written policy does not apply to the Deductible. The Deductible does apply to the Maximum Out of Pocket. | |
| Calendar Year Maximum Out of Pocket Notes | The calendar year Maximum Out of Pocket applies to pharmacy and medical claims. Each individual family member must meet the individual Maximum Out of Pocket unless the family Maximum Out of Pocket has been met by any two or more covered family members. Once met, your covered prescriptions are paid at 100%. Generic Dispense as Written policy does not apply to the Maximum Out of Pocket. | |
Traditional PPO Plan
| Traditional PPO Plan | ||
|---|---|---|
| Retail Pharmacy Coverage (01-30 Day Supply) | In Network Pharmacy | |
| Generic | $15.00 | |
| Preferred Brand | $50.00 | |
| Non-Preferred Brand | $75 | |
| Retail Pharmacy Coverage (01-90 Day Supply) | In Network Pharmacy | |
| Maintenance Generic | $30.00 | |
| Maintenance Preferred Brand Medications | $100.00 | |
| Maintenance Non-Preferred Brand Medications | $150.00 | |
| Mail Order Extended Supply (01-90 Day Supply) | In Network Pharmacy | |
| Generic | $30.00 | |
| Preferred Brand | $100.00 | |
| Non-Preferred Brand | $150.00 | |
| Accumulations | ||
| Maximum Out of Pocket Embedded | $5,000.00 individual / $10,000.00 family | |
| The calendar year Maximum Out of Pocket applies to pharmacy and medical claims. Each individual family member must meet the individual Maximum Out of Pocket unless the family Maximum Out of Pocket has been met by any two or more covered family members. Once met, your covered prescriptions are paid at 100%. Generic Dispense as Written policy does not apply to the Maximum Out of Pocket. | ||
Specialty Medications
Specialty medications are high-cost drugs that are often injected or infused and require special storage and monitoring. These medications must be obtained through Accredo specialty pharmacy by calling Accredo at 1.800.803.2523. Some exceptions apply. These medications are limited to a 30 day supply. Specialty medications largely fall into the formulary brand category but could also fall into the biosimilar or generic specialty drug category. These medications are subject to the appropriate cost share as listed below. Accredo Specialty Pharmacy also offers pharmaceutical care management services designed to provide you with assistance throughout your treatment.
| Specialty Medication (01-30 Day Supply) | Specialty Pharmacy |
|---|---|
| Specialty Generic | 20% Co-insurance |
| Specialty Preferred Brand | 20% Co-insurance |
| Specialty Non-Preferred Brand | 20% Co-insurance |
The My RxBenefits member portal gives you 24/7 online access to your account information, ID card, access to real-time prior authorization status and prescription details. You can also chat with our Member Services team to address any questions. Register for the portal by visiting RxBenefits.com and clicking on “Member Portal.”
Chat: With a live agent by registering for the RxBenefits member portal at Member.RxBenefits.com,
Monday-Friday, 9:00 a.m. to 6:00 p.m. Central
Call: Talk to RxBenefits Member Services at 1-800-334-8134, Monday-Friday, 7:00 a.m. to 8:00 p.m. Central
Email: CustomerCare@RxBenefits.com, Monday-Friday, 7:00 a.m. to 8:00 p.m. Central
Specialty Pharmacy – 1.800.803.2523
Prior Authorizations (PA): 888.608.8851
Benesch HDHP HSA PBC 2027
Benesch Traditional PPO PBC 2027
2027 Prescription Drug Benefits FAQ
RxBenefits Quick Reference Guide
RxBenefits Online
2026 National Preferred Formulary PDL
2026 National Preferred Formulary Exclusion List
Rx Claim Form
Summary of Material Modifications GLP1
SaveOnSP Adapt Copay Assistance Benefit
HDHP-HSA Plan
Your HDHP/HSA plan includes the SaveOnSP Adapt benefit, which works similarly to the standard SaveOnSP program but is designed for HSA-eligible plans. You must first meet your deductible before the benefit applies. Once met, a 30% coinsurance is applied to eligible specialty medications—and SaveOnSP coordinates manufacturer copay assistance to cover most or all of that cost, potentially reducing your responsibility to $0. Note that this coinsurance does not count toward your out-of-pocket maximum. A SaveOnSP representative will reach out when you fill an eligible medication to guide you through enrollment.
Traditional PPO Plan
Your plan includes a copay assistance benefit administered by SaveOnSP that can significantly reduce your out-of-pocket costs on select specialty medications. If you fill an eligible specialty drug, a SaveOnSP representative will contact you to enroll in the manufacturer’s copay assistance program. Once enrolled, your cost may be reduced to as little as $0. If you choose not to participate, you will pay the full plan coinsurance. Note that your cost share under this benefit does not count toward your deductible or out-of-pocket maximum.