Prescription Benefits (Last day of Coverage is December 31, 2021)
Claim Administrator: Elixir (formerly EnvisionRx): 833-652-2799 or 833-OLABRX9
Copayments: Copayments will vary depending on whether you fill your prescription at a retail pharmacy or through mail order. Costs also depends on how the drug is classified on Elixir’s drug formulary.
|Retail Pharmacy (30-day supply)||Mail Order (90-day supply)|
|Brand Name Preferred||$30||$75|
|Brand Name Non-Preferred||$50||$125|
Mandatory Mail Order: You must use the mail order pharmacy to fill prescriptions for maintenance medications (certain exceptions may apply). You are permitted to use a retail pharmacy three times for a maintenance medication. Mail order refills require a 90-day prescription.
Mandatory Generic Drugs: If a generic is available, the Fund will only pay the cost of the generic drug. If you or your physician request a brand name drug instead of a generic, you will be responsible for paying the cost difference between the generic and brand name drug in addition to the higher copayment. There is an available cost difference cap of $50 per 30 day supply and $100 per 90 day supply. To be eligible for the cap, a “Brand-Name Drug Override” form will be required from your prescribing doctor. Please contact Elixir to request the form be sent to your doctor.
Step Therapy: Certain medications may qualify for a step therapy program. Step therapy requires you to first attempt lower cost drugs to treat an ongoing condition. Step therapy helps you and the Fund control the rising costs of drugs. Drugs will be added to or removed from the step therapy program when deemed appropriate by the Fund. Certain exceptions may apply in cases of allergy or certain medical conditions. Your doctor would need to call the Elixir Prior Authorization Department to request an exception be made.
Free Diabetes Testing Supplies: You can get the following diabetes testing supplies at no cost through Elixir:
- Insulin needles and syringes
- Lancets and devices (spring or powered)
- Blood glucose testing strips for home glucose monitors
- Normal, low, and high calibrator solution/chips
- Alcohol wipes
To receive the above noted supplies at no cost, you must get a prescription from your doctor. The supplies will be subject to mandatory mail order; therefore, we recommend you ask your doctor for a 90-day prescription.