total rewards 01c

total rewards 02b

.
your health banner

Prescription drug benefits are a part of Palmetto Health’s group medical plans. Plan participants are eligible for 30-day or extended-day (90-day) supplies. There is no deductible for preventive drugs. Preventive drugs include those taken for a disease that has not yet manifested or to prevent recurrence of a disease. Examples include cholesterol-controlling medication and blood pressure medication.

All maintenance and specialty medications must be filled at the Palmetto Health Pharmacy in order to be covered under the plan. Please click here for a list of specialty medications. Any prescription is considered a maintenance medication after it has been refilled twice. After the second refill, maintenance medications must be filled at the Palmetto Health Pharmacy.

The medical plan offers several pharmaceutical management programs including Step Therapy, Prior Authorization and Maintenance Medication Management. These programs require plan members to meet certain requirements for the medical plan to cover a medication. The Palmetto Health Pharmacy can help plan members navigate the requirements of these programs.

Your Pharmacy Options

 

Your Prescription Drug Costs

The following chart is only an overview. You should refer to your Summary Plan Description for any exclusions or limitations that may apply.

Pharmacy (2018 Prescription Drug Costs)

Pharmacy

 

Preventive

Non-Preventive

30-Day

90-Day

30-Day

90-Day

Palmetto Health and CVS Pharmacies

Caremark Network

Palmetto Health Pharmacy

Palmetto Health and CVS Pharmacies

Caremark Network

Palmetto Health Pharmacy

Generic

$10 copay

$15 copay

$20 copay

$10 copay, after deductible

$15 copay, after deductible

$20 copay, after deductible

Preferred

$20 copay

$35 copay

$40 copay

$20 copay, after deductible

$35 copay, after deductible

$40 copay, after deductible

Non-preferred

$40 copay

$65 copay

$80 copay

$40 copay, after deductible

$65 copay, after deductible

$80 copay, after deductible

Specialty

n/a

80% ($100 max), after deductible – Specialty Network Only

n/a

Infertility

n/a

80% ($100 max), after deductible($5,000 life max)

n/a

Click here for a list of preventive medications.

1. Plan participants are eligible for a 30-day or an extended-day (90-day) supply.
2. All maintenance medications must be filled at the Palmetto Health Pharmacy in order to be covered under the plan.
3. Specialty drugs are only available through the Palmetto Health Pharmacy and require prior authorization.
4. Step Therapy is required for medications prescribed to treat ongoing medical conditions.
5. The Palmetto Health Pharmacy doesn’t compound medications or mail controlled substances.

Using the Palmetto Health Pharmacy

Palmetto Health Pharmacy
10 Richland Medical Park Dr.
Columbia, SC 29203
803-434-6482

       Hours of operation:
  • Monday, Wednesday and Friday, 7:30 a.m. – 6 p.m.
  • Tuesday and Thursday, 7:30 a.m. – 8 p.m.
  • Saturday, 8:30 a.m. – 1 p.m.
  • Sunday, 10:30 a.m. – 3 p.m.

Palmetto Health Pharmacy offers the following options to Palmetto Health team members and dependents participating in either the Palmetto Health Reimbursement Account medical plan or the Palmetto Health Savings Account medical plan:

  • Pick-up for 30-day (or less) supply prescriptions
  • Pick-up for 90-day (or extended-day) supply prescriptions
  • Fee mail-order for 90-day (or extended-day) supply prescriptions*

Need a refill? Visit WebRx.PalmettoHealth.org to request refills or to check the status of your online order. Team members can visit http://PHFormulary.net to access important pharmacy forms.

The Palmetto Health Pharmacy doesn’t compound medications or mail controlled substances. Watch a very brief video about our pharmacy benefit below. Per IRS regulations, the medical plan’s pharmacy benefit structure categorizes medications as preventive and non-preventive. See the list below for preventive drug categories. Please note, any drug not listed on the preventive list is considered non-preventive.

    • Anti-obesity agents
    • Anticonvulsants
    • Antihyperlipidemics
    • Antipsychotics
    • Breast cancer prevention
    • Contraceptives
    • Asthma
    • Blood thinners
    • Coronary artery disease
    • Diabetes
    • Depression
    • Fluoride supplements
    • Hypertension
    • Human immunodeficiency virus (HIV)
    • Smoking deterrents
    • Immunosuppressants
    • Vitamins
    • Immunizing agents
    • Allergenic extracts
    • Multiple sclerosis
    • Osteoporosis

Non-preventive medications must be paid for out-of-pocket by plan members until the medical plan deductible has been met. Once the deductible has been met, plan members pay a co-pay for all medications. Preventive medications are not subject to the medical plan deductible, so team members pay a co-pay. Please see the Pharmacy Benefits tables on the Palmetto Health Reimbursement Account medical plan and Palmetto Health Savings Account medical plan pages of this guide for pharmacy benefit coverage.

Accepted payment methods:

  • Cash
  • Payroll deduction
  • Personal check
  • Money order
  • Health Reimbursement Account (HRA) funds**
  • Health Savings Account (HSA) debit card
  • Flexible Spending Account card (Benny® Debit Card)
  • Visa/MasterCard/Discover/American Express

*Palmetto Health Pharmacy requires a mail-order form/agreement to be filed per individual prior to mailing any prescriptions. This is available on myPal and at http://PHFormulary.net . If you have completed a form in the past and have changes please complete the Mail Order Refill/Update form that can be found on http://PHFormulary.net.

**Health Reimbursement Account (HRA) funds are automatically used to pay medical and pharmacy claims. Team members must use HRA funds before paying out-of-pocket. This applies only to members of the Palmetto Health Reimbursement Account medical plan. Please contact BlueCross BlueShield of South Carolina at 866-654-5227 to learn more about HRAs.

Palmetto Health Pharmacy information and forms may be accessed via http://mypal/Tools-Resources/Forms/Total-Rewards-Forms or www.EnrollOnline.com/palmettohealth.

Related Links

Enrollment Information

New Benefits for 2018

Have a Question?
Contact the Total Rewards Benefits Center at 800-963-3456 or 803-296-8893, or email TotalRewards
@PalmettoHealth.org