Prescription Benefits

All of our medical plans include prescription drug benefits. You can fill up to a 30-day supply at any retail pharmacy in the network. Just present your Capital Rx ID card and make the required payment. Covered drugs are listed on the plan’s drug list, also known as the formulary.

To learn more about Capital Rx before enrollment, view the Capital Rx Employee Drug Pricing Tool or scan this QR code:
qrcode_enrollment.cap-rx.com

Below is an overview of the prescription benefits.

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UNITED HEALTHCARE (UHC) Network Plan Tiered Plan One Step Plan
(Closed to New Entrants)
Plan Benefits In-Network
Deductible (ded.) No deductible Medical deductible applies (excludes preventive care
medications)		 Medical deductible applies
Retail Prescriptions (30-day supply)
Generic / Preferred Brands / Non-preferred brands
 $12 / $60 / $100 $10 / $50 / $100 0% after ded.
Mail Order (90-day supply)
 $24 / $120 / $200 $20 / $100 / $200 0% after ded.
Costco Specialty Pharmacy Medications (30-day supply)* $12 / $60 / $100 $10 / $50 / $100 N/A
Human Growth Hormone Medication Not Covered Covered 50% after deductible until out-of-pocket maximum is reached, then covered 100%. Prior authorization required. Covered 50% after deductible until out-of-pocket maximum is reached, then covered 100%. Prior authorization required.
Fertility / Infertility Medication Not Covered Covered 50% after deductible until out-of-pocket maximum is reached, then covered 100%. $10,000 lifetime Rx maximum. Prior authorization may be required. Covered 50% after deductible until out-of-pocket maximum is reached, then covered 100%. $10,000 lifetime Rx maximum. Prior authorization may be required.
* Must use Costco Specialty Pharmacy prescription drug card program.

You pay a copay for each prescription you fill. You’re responsible for the difference in cost if you choose a brand name over a generic prescription. There’s no coverage for fertility/infertility or human growth hormone medication.

Prescription drugs are covered after you meet the medical plan’s annual deductible. There is no separate prescription drug deductible. However, you are responsible for copays and the difference in cost if you choose a brand name over a generic prescription. The plan's annual deductible is waived for preventive medications.

Once you meet your deductible, GT covers eligible prescription drugs 100%. All prescription medications, including non-ACA preventive drugs, are subject to the deductible. If you choose to get a brand-name drug, you will be responsible for the difference in cost between that drug and the less-expensive generic alternative.

If you are prescribed a maintenance medication (e.g. long-term conditions like arthritis, asthma, diabetes, high blood pressure or high cholesterol), you can fill your 30-90 day prescription at retail pharmacies or through mail service by visiting rx.costco.com.

GT medical plans include drug management programs to ensure you receive, safe, cost-effective medications. You and your health care provider may be asked to try a more cost-effective, therapeutically appropriate medication before progressing to a more costly option. Additionally, your provider may be asked for more information before certain drugs are approved.