Prescription Drug Plan
The prescription drug program is the same for all three health care plans – Choice, Save and Focus. However, with Choice and Focus Plans, prescription drugs are not subject to the deductible and the plan will pay according to the schedule below in January.
Remember that with the Save Plan, the full cost of prescription drugs must be paid for by you until your deductible is met. Once your deductible is met, the prescription drug plan will pay as listed on the schedule below. The only exception is the list of Safe Harbor medications. The Safe Harbor list allows Save Plan members to receive those medications at the same cost as the Choice and Focus Plans before meeting the deductible.
Manufacturer copay savings cards or coupons used at the pharmacy will NOT be applied to your deductible or out-of-pocket maximum amounts. Only your TRUE out-of-pocket expense will apply to the deductible and out-of-pocket maximum.
Do you live outside of the Alamance, Guilford or Rockingham County areas in North Carolina or in Virginia or just having a hard time getting to the Cone Health Outpatient Pharmacies before they close? Cone Health operates a Mail Order service out of the Wesley Long Outpatient Pharmacy for employees who live in North Carolina and Virginia (the states where we are licensed to provide mail order). There are NO shipping charges for Cone Health Mail Order services.
Complete a Mail Order Form
NEW - Specialty Pharmacy Services
Beginning January 1, 2022, members of our benefits plans will be required to work with our Cone Health Specialty Pharmacy when filling select Specialty medications. Our Specialty team is dedicated to providing services that will facilitate best practices while alleviating barriers to access resulting in a better experience for our members. Services include and not limited to ongoing clinical support to minimize adverse events, increased adherence to medication through refill reminders, and assistance with copay cards to reduce your out-of-pocket costs.
Diabetes Pharmacy Benefit & Rewards Program
Cone Health is dedicated to expanding the pharmacy benefit coverage of diabetes medications and supplies through a rewards program. You and your dependents actively engaged in Active Health Management (AHM) are eligible to earn cash rewards through a quarterly payroll payout to offset your diabetes medication and supply costs.
- Maintenance drugs must be filled by the Cone Health Outpatient Pharmacies, either in person or by Cone Health mail order. Only one 30-day prescription will be available at retail stores
- A prior authorization will be required for any branded medication that has a generic equivalent.
Prescription Benefit Related Documents