Two-Tier Generic Pharmacy BenefitApril 23, 2019
We’re excited to extend the two-tier generic pharmacy benefit to large group (Illinois only) and self-funded (all states) new sales and renewals with an effective date of July 1, 2019, or later. Currently, the two-tier generic pharmacy benefit is offered to small groups and individuals on 2019 ACA plans.
The benefit consists of two tiers:
- Tier 1: $0 preferred generics (except HSA-compatible plans)
- Tier 2: Non-preferred generics at the standard generic cost-sharing amount
This replaces the Rxtra program and will allow members to use any Health Alliance-contracted pharmacy.
Renewing groups with an effective date of July 1, 2019, or later can renew on their existing one-tier generic pharmacy benefit, or they can select their current plan with the new two-tier generic pharmacy benefit.
All alternate standard plan offerings (listed in the rate portfolio) will include the two-tier generic pharmacy benefit. If you would like to see an alternate plan with the one-tier generic pharmacy benefit, please contact your client consultant.
Call your client consultant with any questions, or contact Broker Support at 1-877-917-8489 or BrokerServices@healthalliance.org.