HEALTH

Pharmacy

When you enroll for medical coverage, you automatically receive prescription drug coverage, managed through OptumRx. Prescription drug benefits are determined by which medical plan option you enroll in and the type of medication you require.

If you are not yet enrolled in a medical plan and would like more information on prescription drug coverage, visit optumrx.com/oe_eaton/landing.

If you are already enrolled in a medical plan, visit werally.com/eaton where you can be directed to OptumRx and Surest. From there, you can review your cost by plan (including out of pocket costs), as well as your covered medications and their respective prices.

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OptumRx

OptumRx provides convenient and flexible options for the prescription drugs you and your family may need. The pharmacy network includes access to thousands of retail locations, including large, national chains and many community pharmacies. For medications you take regularly, you can also use the OptumRx home delivery pharmacy.

Enhanced and Basic Medical Plans. The amount you’ll pay for prescription drugs will depend on whether you are filling a generic, formulary brand, or non-formulary brand drug. The table below outlines the specific costs under the plans.

DRUG CATEGORY	GENERIC/FORMULARY BRAND/NON-FORMULARY BRAND	TIER 1 AND TIER 2 PREVENTIVE DRUGS
How the Benefit Works	Until you reach the annual deductible, you pay 100%.	You pay 0%.
After you reach the annual deductible and before you reach the annual out-of-pocket maximum (up to a 30-day supply at retail and up to a 90-day supply through mail order), you pay 20%. Your maximum payment each time you fill a prescription is $500.	The deductible does not apply. Covers only generics in Tier 1 (certain exceptions may apply).
After you reach the Plan’s annual out-of-pocket maximum, you pay no out-of-pocket cost for covered medications for the rest of the year.	Covers only generics in Tier 2 — unless a generic is not available in the category or class.

DRUG CATEGORY

GENERIC/FORMULARY BRAND/NON-FORMULARY BRAND

TIER 1 AND TIER 2 PREVENTIVE DRUGS

How the Benefit Works

Until you reach the annual deductible, you pay 100%.

You pay 0%.

After you reach the annual deductible and before you reach the annual out-of-pocket maximum (up to a 30-day supply at retail and up to a 90-day supply through mail order), you pay 20%. Your maximum payment each time you fill a prescription is $500.

The deductible does not apply. Covers only generics in Tier 1 (certain exceptions may apply).

After you reach the Plan’s annual out-of-pocket maximum, you pay no out-of-pocket cost for covered medications for the rest of the year.

Covers only generics in Tier 2 — unless a generic is not available in the category or class.

MyChoice Plan. The amount you’ll pay for prescription drugs will depend on whether you are filling a generic, preferred brand, or non-preferred brand drug. The table below outlines the specific costs under the plan.

You can look up the cost of any specific medication by using the OptumRx Drug Pricing Tool.

	30-DAY SUPPLY	90-DAY SUPPLY	SPECIALTY
Tier 1: Generic	$20	$50	$440
Tier 2: Preferred Brand	$150	$375	$480
Tier 3: Non-preferred Brand	$250	$625	$530

Keep in mind: Maintenance medications (those that you take long-term or for ongoing conditions) require mail-order delivery. See Mail Order and Walgreens 90-day Rx below for more information.

If you do not use mail order or generic drugs when available, you may pay substantially more, possibly up to 100% of the cost of the drug.

Preventive Medications

Eaton offers special coverage for certain preventive medications that help protect against or manage a medical condition, such as:

Preventing blood clots and reducing risk of a stroke
Preventing heart disease and reducing high blood pressure
Preventing osteoporosis
Diabetes

In addition, under the Affordable Care Act (ACA), certain Preventive Care Medications are covered at 100% without charging a coinsurance or meeting a deductible. You can use your member ID card to get these medications at no cost if they are:

Prescribed by a health care professional
Age and condition appropriate
Filled at a network pharmacy

The drugs on the Preventive Medications List are also not subject to a deductible or coinsurance. Eaton offers this special coverage so you can save money and get the medications you need to help you live a healthier life. If you get these drugs from an out-of-network pharmacy, you will have to pay the full cost for them. Take a look at the Preventive Medications List to see if any of your medications fall into this category.

Mail Order, Walgreens Retail 90 and Extended Pay Program

Walgreens Retail 90 lets you choose how you get 90-day supplies of maintenance medications—conveniently delivered to your home through Optum home delivery, or in person at more than 9,000 Walgreens pharmacies nationwide. Whichever option you choose, you pay the same prices for all 90-day refills.

Ordering your prescriptions via mail service is fast and convenient. If you are managing long-term or chronic conditions, using this mail service pharmacy makes sense—you can purchase up to a three-month supply of most prescription medications.

Once OptumRx receives your complete order for a new prescription, your medications should arrive within ten business days. Completed refill orders should arrive within seven business days. If the pharmacy needs to contact you or your doctor to get additional information, it may take longer. Contact a Health Advisor at 1-844-391-1889 for more information.

The Extended Pay Program is a convenient and no cost home-delivery program for your prescription drugs. The program helps you to spread the cost of your medication over three smaller monthly installments, so you don’t have to pay for your medications all at once. Your order is shipped after your very first payment, so there’s no waiting and no need for multiple trips to the pharmacy! Interested in participating? Go to OptumRx through werally.com/eaton to apply the program to your order. For more help, call the customer service hotline.

Specialty Medications

Medications used to treat complex or rare conditions may need to be obtained from a specialty pharmacy. To help you fill these medications, and manage your care and prescription, OptumRx offers its Specialty Pharmacy.

A Patient Care Coordinator from Optum Specialty Pharmacy will help you enroll in this program when the Pharmacy receives your request to fill a specialty medication. The coordinator will also help you schedule your next medication delivery and manage your medical supplies. You’ll receive a welcome packet to explain the program as well.

Wondering if your specialty medication is covered? Visit whyuhc.com/eaton/pharmacy-plans.

Price Edge

Price Edge scans available discounts (e.g., GoodRx) and compares them to your pharmacy member benefit, automatically returning the lowest price available for non-specialty, generic drugs. Simply show your ID card and a prescription from your doctor at any network pharmacy. Price Edge pricing is also reflected when you use the drug pricing tools on OptumRx.com and the Optum Rx app, once you’ve enrolled and registered.