Schedule I3 Non-Medicare Prescription Drug Summary of Benefits.pdf

This is a Summary of Benefits document for Schedule I3 Non-Medicare Prescription Drug Benefits associated with RFP No. 230000003226. The document outlines prescription drug coverage changes effective January 1, 2024, for non-Medicare members. Key changes include the elimination of 10% additional coinsurance for 31-day supplies of maintenance medications at retail pharmacies, the addition of 90-day supply coverage at retail locations, and the expansion of specialty medication coverage beyond Optum Specialty to non-preferred pharmacies with a 40% coinsurance structure featuring a $50 minimum and no maximum out-of-pocket limit. The document also details the implementation of a specialty copay card solution to provide accurate out-of-pocket cost tracking toward members' deductibles and out-of-pocket maximums.

The non-Medicare prescription drug plan modifications align coverage levels with existing Medicare member benefits to create consistency across plan offerings. Members will gain access to divvyDOSE pharmacy services, which provides full-service medication pre-sorting and organization by day, date, and time for prescriptions, vitamins, and supplements. These changes reflect a broader effort to enhance prescription drug coverage flexibility, expand pharmacy options, and improve member cost transparency and convenience in medication management.