Prescription Drugs
When you enroll in the Stimson medical plan, you automatically have prescription drug coverage through Aetna.

How It Works

You pay the full cost for prescription drugs until you meet the medical plan deductible. Then you pay the applicable coinsurance. The deductible does not apply to certain preventive medications.

Your cost for prescription drugs depends on whether you use generics, preferred brand drugs, non-preferred brand drugs or specialty drugs. To find out, log on to Aetna website.

You can fill a prescription at an in-network retail pharmacy or through the mail order service.

In-Network Retail Pharmacy

  • An in-network pharmacy will submit a claim on your behalf. If you go to an out-of-network pharmacy, you must pay for your prescription and submit the Prescription Drug Claim Form for reimbursement.
  • If you choose a brand name drug instead of the generic equivalent, you will pay the brand name drug copay, and the cost difference between the brand name drug and the generic.
  • Certain drugs may require pre-authorization, step therapy or have dispensing limits. This can change annually if you choose a brand name drug instead of the generic equivalent.
  • You might need to purchase specialty injectable prescriptions from a specific provider.

Note: If you use an out-of-network pharmacy, you’ll pay the full price for the prescription.

Mail Order

Maintenance medications (drugs you take on a regular basis to treat a chronic condition) must be purchased through Aetna Rx Home Delivery. When you use mail order, you get a 90-day supply for the same copay amount as a 44-day supply at a retail pharmacy.

At-A-Glance

Here’s a quick look at the Stimson prescription drug plan. For plan details, review the Aetna Medical Plan Design and Benefits.

Up to 44-day Supply 45- to 90-day Supply
RETAIL What You Pay
Select Preventive/Chronic Medications*

Generic: $0

Brand: $15 copay

Generic: $0

Brand: $30 copay

Generic $10 copay $20 copay
Preferred Brand $25 copay $50 copay
Non-Preferred Brand 50% copay, up to $150
Specialty Drugs**

Generic: $10 copay

Preferred Brand: $25 copay

Non-preferred Brand: 50% copay, up to $150

Generic: $20 copay

Preferred Brand: $50 copay

Non-preferred Brand: 50% copay, up to $150

90-day Supply
MAIL ORDER What You Pay
Select Preventive/Chronic Medications*

Generic: $0

Brand: $15 copay

Generic $10 copay
Preferred Brand $25 copay
Non-Preferred Brand 50% copay, up to $150
Specialty Drugs**

Generic: $10 copay

Preferred Brand: $25 copay

Non-preferred Brand: 50% copay, up to $150

*Deductible does not apply to certain preventive medication. Review Aetna’s Preventive Medicine List.
** Your first prescription for a Specialty Drug must be filled at a retail pharmacy or Aetna Specialty Pharmacy®. You must purchase refills through Aetna Specialty Pharmacy.

KEY TERM

Preferred Brand Drugs

Generally, these are drugs for which no generic equivalent is available. They are listed on Aetna’s “formulary list” and may cost less than drugs not on the list.

KEY TERM

Non-Preferred Brand Drugs

Generally, these are the highest cost drugs that have recently come on the market. In most cases, an alternative preferred drug is available.

KEY TERM

Specialty Drugs

Specialty drugs treat chronic health conditions that are very expensive such as hemophilia, rheumatoid arthritis, multiple sclerosis and cancer. Specialty drugs can be injected, infused or taken by mouth.

Manage Prescription Costs

Here are some ways to help manage the cost of your prescription drugs:

Preventive Medications
For certain chronic conditions, the deductible does not apply to your preventive medicine. You just pay the applicable copay/coinsurance. Review the Preventive Medicine List.

Mail Order Pharmacy
Save money and time on maintenance medications when you use the mail order option through Aetna Rx Home Delivery.

Open an HSA
Use the tax-free HSA to pay for your prescriptions before you meet the medical plan deductible.