What Is the Pharmacy Program?
Many medications can be too expensive without insurance or a drug benefit program to help with the cost. The University works with Prime Therapeutics and Fairview Specialty Pharmacy to ensure access to a select formulary of medications for all eligible employees and their dependents. Prime Therapeutics covers most medications, whereas Fairview Specialty Pharmacy covers medications for complex medical conditions.
Who Is Eligible?
Once you sign up for your medical plan, you are also enrolled in the prescription drug benefit program. You’ll receive a separate ID card from Prime Therapeutics that you can also use for Fairview Specialty Pharmacy. Present the card at your local pharmacy when you have your prescription filled.
Prescription Benefit Levels
The list of drugs in the formulary through Prime Therapeutics provides you with safe, effective, high-quality, cost-effective medications to ensure the best medical results. The University pharmacy managers have a strong emphasis on the use of generic medications to help control the cost of prescription drugs.
Prime Therapeutics covers a 30-day supply of prescription medications (including insulin) through network pharmacies at the following level:
- $0 copay for select preventive medications specified in the Affordable Care Act, including contraceptives in the Generic Plus category. Medica HSA covers these medications at 100%.
- $10 copay for Generic Plus (Tier 1) medications, which covers all generic drugs and certain preferred brand medications for which there is no generic therapeutic equivalent
- $30 copay for Brand Formulary (Tier 2) medications, which includes all other brand name medications listed on the formulary
- $75 copay for Non-Formulary (Tier 3) medications, which includes all covered brand name medications not listed on the formulary
For Medica HSA, prescriptions can be covered either with money from the account or applied to the annual deductible until it is met. After that, the medical plan pays 90% of the pharmacy expenses.
The University of Minnesota Formulary, found on the Prime Therapeutics website, lists the medications that are covered by the program.
Specialty drugs are provided through Fairview Specialty Pharmacy. Specialty drugs are generally prescribed for people with complex or ongoing medical conditions and the drugs themselves are often subject to unique storage or shipment requirements.
Members receive education and support from a health care professional through Fairview Specialty Pharmacy due to the complexity of use and the potential for some serious side effects.
Prime Therapeutics has a broad Minnesota and national retail pharmacy network that includes popular chains, clinic and hospital pharmacies, independent pharmacies, and a home delivery mail service pharmacy. Fairview Specialty Pharmacy provides home delivery or pick-up service for specialty drugs at Fairview clinic and hospital retail pharmacies. Specialty medications are also available through Essentia Health and Northland in Duluth.
Medication Therapy Management (MTM)
The purpose of Medication Therapy Management is to be sure that your medications are appropriate, effective, safe, and convenient. Learn more about the MTM program on the Medication Therapy Management page.