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Prescription Drug Plan Overview

By enrolling in the Scripps Health Plan, you are automatically enrolled in the Prescription Drug Program administered by MedImpact, a Pharmacy Benefits Manager (PBM). The Prescription Drug Program offers you the flexibility to obtain your medications either at a retail network pharmacy or through the prescription mail order service.

How the Program Works

You have three ways to obtain your medications through the Prescription Drug Program:

MedImpact Retail Pharmacies

Prescription drugs that you take for a short time or need right away, you should have filled at a participating MedImpact pharmacy. Present your ID card and pay the appropriate copay for up to a 30-day (1 month) supply of your prescription. To locate a participating provider, please click here.

Choice90 Retail Pharmacies

Certain long-term and maintenance medications (drugs that your physician prescribes for use on a regular basis for chronic conditions such as diabetes, high blood pressure, asthma, ulcers or high cholesterol) may be obtained at select retail Choice90 pharmacies. Present your ID card and pay the appropriate copay for up to a 90-day (3 month) supply of your prescription. Please visit MedImpact to find a participating Choice90 pharmacy near you.

Mail Order Service

You can receive up to a 90-day supply of prescription drugs that you take on an ongoing or "maintenance" basis (drugs that your physician prescribes for use on a regular basis for chronic conditions, such as diabetes, high blood pressure, asthma, ulcers or high cholesterol), mailed to your home through the mail order program. The mail order program is offered through Scripps Ambulatory Pharmacies or MedImpact Direct. To enroll in this convenient service, complete the Scripps Health Ambulatory Pharmacy Medication Order Form and fax it along with your prescriptions to 619-686-3932 or call 858-964-1013 if you have any questions.

For Mail order services log into you account at http://www.medimpact.com, then complete and submit out the order form under the document tab.

The table below highlights the benefits available under each pharmacy option:

Drug Type MedImpact
Retail Pharmacy
(30 day supply)
Choice 90 Pharmacy
Retail Pharmacy
(90 day supply)
Mail Service
Pharmacy
(90 day supply)
Annual Out-of-Pocket Maximum* $2,500 per person; $5,000 per family
Generic $10 copay $20 copay $20 copay
High Cost Generic
(cost over $50 with relevant alternatives)
$35 copay $87.50 copay $87.50 copay
Preferred/Formulary $35 copay $87.50 copay $87.50 copay
Non-Preferred/Non-Formulary $55 copay $165 copay $165 copay
Specialty Medications When filled at MedImpact: 25% coinsurance per prescription (minimum $75, maximum $150); prior authorization required; When filled through the Care Partner program: $0 copay
* Annual out-of-pocket maximum for prescription drugs is separate from Scripps Health Plan out-of-pocket maximum.

Effective January 1, 2013, copays are waived for oral contraceptives

The amount of your copay depends on the type of drug and its inclusion on the formulary/preferred drug list:
  • Generic Drugs

    You pay the lowest copay for generic drugs. These drugs are sold under the drug’s chemical name and contain the same active ingredients and equivalent strength and dosage to the brand-name equivalent.
  • High Cost Generic Drugs

    Generic drugs costing over $50 that have a relevant alternative.
  • Brand Drugs on Formulary/Preferred Drug List

    You pay a lower copay for drugs on the formulary/preferred drug list. If you elect to receive a brand medication when a generic is available, you will pay the price difference between the brand and generic, plus the brand copay.
  • Brand Drugs Not on Formulary/Preferred Drug List

    You pay the highest copay on brand drugs not on the formulary/preferred drug list. If you elect to receive a brand medication when a generic is available, you will pay the price difference between the brand and generic, plus the brand copay.

Save Money on Prescriptions Not Covered by Your Medical Plan

As part of your prescription drug benefit, you automatically participate in the iRx Program™ which allows you to save money on prescription drugs not covered under Scripps Health Plan. On average, you can save 25 percent (with potential savings as high as 75 percent)* when you use a participating pharmacy for a drug that qualifies for a discount. More than 60,000 participating pharmacies accept the iRx Program™, including most participating MedImpact pharmacies.

How it Works

  • Present your prescription and your Scripps Health Plan ID card at a participating pharmacy.
  • Savings are automatically applied when the medication prescribed is not covered under Scripps Health Plan and qualifies for a discount.
  • Prescriptions that qualify for a discount through the iRx Program™ are automatically cross-referenced with your other prescriptions to check for safety issues, such as drug interactions.
  • There are no limits on the number of times the program can be used.
  • You are automatically enrolled as part of your Scripps Health Plan coverage, and you pay no separate enrollment or maintenance fees.

For more information on regarding your pharmacy coverage, please go to www.scrippshealthplan.com and select the ‘I’m a Member’ option.