Pharmacy Benefits - Administered by A&I Benefit Plan Administrators, Inc.

Pharmacy Benefits

The Western States Trust Fund of the OPEIU makes pharmacy benefits available to you depending on the option you select for medical coverage. Please review the charts below for more details or refer to your benefits booklet.

Active Participant Benefit Options

Prescription Drugs	LifeWise PPO Benefit Through Express Scripts	PacifiCare HMO	Kaiser HMO
Pharmacy Retail
Generic	$10 or 20% (whichever is less)	$5 Formulary	$15 Formulary
Preferred Brand	$20 or 20% (whichever is less)	$20 Formulary	$15 Formulary
Non-Preferred Brand	50%	N/A	N/A
Mail Order (up to 90-day supply)
Generic	$20 or 20% (whichever is less)	$10 Formulary	$30 Formulary
Preferred Brand	$40 or 20% (whichever is less)	$40 Formulary	$30 Formulary
Non-Preferred Brand	50%	N/A	N/A
Prescription Drug Calendar Year Out-of-Pocket Maximum	$2,500 per person	None	None

Retiree Benefit Options

Prescription Drugs	LifeWise PPO Benefit Through Express Scripts	PacifiCare HMO Benefit Through Express Scripts	Kaiser HMO
Pharmacy Retail
Generic	$10 or 20% (whichever is less)		$15 Formulary
Preferred Brand	$20 or 20% (whichever is less)		$15 Formulary
Non-Preferred Brand	50%		N/A
Mail Order (up to 90-day supply)
Generic	$20 or 20% (whichever is less)		$30 Formulary
Preferred Brand	$40 or 20% (whichever is less)		$30 Formulary
Non-Preferred Brand	50%		N/A
Prescription Drug Calendar Year Out-of-Pocket Maximum	$2,500 per person		None

GENERIC SUBSTITUTION IS MANDATORY UNDER THE "EXPRESS SCRIPTS" PLANS WHEN A GENERIC IS AVAILABLE. IF YOUR DOCTOR HAS SPECIFIED "DISPENSE AS WRITTEN" YOUR PRESCRIPTION WILL BE FILLED WITH THE BRAND NAME.