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Two-Tier Generic Pharmacy Benefit

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