Prescription Drug
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Without insurance, prescription drug costs can soar quickly. Not with your FanDuel coverage, though. Your medical plan comes with prescription drug insurance to cover antibiotics for stomach bugs, asthma inhalers, insulin, and more.
Medications Made Easy
Your medical and prescription drug plans work in tandem. Every FanDuel medical plan automatically comes with prescription drug coverage. And any amount you pay out of pocket for medications counts toward your annual out-of-pocket maximum.
The amount you pay for prescriptions depends on four factors:
- Whether or not you visit an in-network pharmacy
- Whether you fill your prescription in person or through the mail
- The tier of your prescription
- Your medical plan
Network Pharmacies
If you’re enrolled in the Consumer Advantage with HSA, $500 PPO, $1,500 PPO, or EPO plan, getting your prescriptions is simple. Almost all major pharmacies are in your plan’s network. Feel free to fill your prescriptions at CVS, Walgreens, Duane Reade, Costco, or your local grocery store.
Kaiser HMO members:
Retail and Mail-Order Pharmacies
A retail pharmacy is a physical building, like a brick-and-mortar CVS or Walgreens. A mail-order pharmacy—you guessed it—isn’t.
Retail pharmacies generally only fill up to 30 days of your prescription at a time, but FanDuel allows you to receive a 90-day prescription from a retail pharmacy, if you prefer to receive a longer-term option. However, keep in mind that the 90-day retail benefit will cost you three times the amount of the 30-day retail prescription.
Go postal
Seriously, do it if you need a 90-day supply of your prescription. For most medications, you get three 30-day supplies for the price of two. Instant savings!
Drug Tiers
Each prescription you take falls into one of three tiers: generic, preferred, and non-preferred and specialty.
Generic drugs are the least expensive ones, but they aren’t any different in quality. They have the same chemical makeup as their counterparts in the next tier.
Preferred drugs are more expensive, brand-name versions of generic drugs, or drugs that don’t have generic alternatives yet. Think of it like the difference between store-brand ketchup and the brand of ketchup everyone knows about.
Your insurance company has a list of all the drugs without generic alternatives that are covered at this level instead of the next, more expensive tier. That list is called a formulary. Anthem members, here’s your formulary. Kaiser members in Northern California, here’s yours. In Southern California, here’s yours.
Non-preferred drugs and specialty drugs are really two different kinds of drugs that share the same tier. Non-preferred drugs are brand-name drugs that are not included on your insurance provider’s formulary but are still covered—at a higher cost. Specialty drugs require special handling and are for chronic and/or serious conditions. Drugs in this tier are the most expensive.
What if my drug isn’t covered?
If your drug isn’t on your insurance provider’s formulary, it might not be covered. Drugs that are experimental or haven’t yet met FDA standards generally aren’t approved. Contact your insurance provider or Health Advocate for assistance.
