Prescription Drugs
We have your prescription drugs covered with whatever medical plan option you choose. You’ll receive prescription benefits through OptumRx. When covered prescriptions are filled under the prescription drug program, you share a portion of the cost and Bath & Body Works pays the rest.
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How the Prescription Drug Tiers Differ
The amount you pay for a prescription drug is based on the type of drug you fill, whether it’s a generic, preferred brand or non-preferred brand. Here’s how the costs compare based on the tier of drug you fill:
Tier 1
Lowest Coinsurance Option. Always consider tier one medications if you and your doctor decide they are right for your treatment.
Tier 2
Middle Coinsurance Option. Consider tier two medications if you and your doctor decide there are no tier one options appropriate to treat your condition.
Ask your doctor if there are tier one alternatives or over-the-counter brands that are equivalent to tier two medications — they may be used to treat the same condition, but are less expensive.
Tier 3
Highest Coinsurance Option. If you are currently taking a medication in tier three, ask your doctor whether there are tier one or two alternatives appropriate for your condition.
Compounded medications containing one or more ingredients that are prepared on-site by a pharmacist are classified at the tier three level, provided that the individual ingredients used in compounding are covered under the pharmacy benefit.
Coordinating with a Copay Card
Manufacturer copay cards are a way to save on medications. They can help you afford expensive prescription medications by lowering your out-of-pocket costs. You can request a copay card from your drug’s manufacturer or your prescriber and can enter it on optumrx.com to be sure it’s applied to your fill.
If a copay card (manufacturer assistance) is used to fill specialty medications at an Optum Specialty Pharmacy to offset the amount you would be charged under the plan, you will only receive accumulator (deductible or out-of-pocket) credit for the amount you pay. You will still receive the benefit of the copay card financially; however, you will not receive the deductible or out-of-pocket credit for amounts you have not paid out of your own pocket. Only your actual out-of-pocket costs are applied to your deductible and out-of-pocket totals.
Calendar Year Pharmacy Out-of-Pocket Maximum
Each medical plan option has a calendar year prescription drug out-of-pocket maximum, which is the maximum amount you will pay out of your pocket for prescription drugs. Once you reach the calendar year out-of-pocket maximum, the plan pays the rest.
| Lower Premium | Lower Deductible | In-Network Only | |
|---|---|---|---|
| Individual | $3,650 | $3,650 | $3,650 |
| Family | $7,300 | $7,300 | $7,300 |
We continually look for ways to keep your out-of-pocket costs low, which is why we haven’t increased our prescription drug out-of-pocket maximums in several years to ensure you’re financially protected if you have a serious illness and need to take high-cost medications.