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Your Unity Prescription Drug Benefit

To verify the pharmacy benefit that you have, look at your Unity member ID card.  For example, you may see one of the following:

• $10 / $20 DRUG (two dollar amounts indicate a two-tier drug benefit)
• $10 / $25 / $50 DRUG (three dollar amounts indicate a three-tier drug benefit)
• DRUGS SUBJECT TO A $2,200 DEDUCTIBLE (a high-deductible HSA benefit)
• NO UNITY DRUG COVERAGE (you don’t have a drug benefit with Unity; may have one with another entity such as Navitus)

If you have a Unity Prescription Drug Benefit, the formulary determines your copay for a medication as well as whether or not the medication requires a Prior Authorization for coverage.

Two-Tier Drug Benefits:

• All non-formulary and restricted drugs require Prior Authorization for coverage
• Generic drugs require a Tier 1 copay
• Brand drugs require a Tier 2 copay

Three-Tier Drug Benefits:

• Restricted drugs require Prior Authorization for coverage
• Generic drugs on the formulary require a Tier 1 copay
• Brand drugs on the formulary require a Tier 2 copay
• Non-formulary drugs require a Tier 3 copay

High Deductible HSA Benefits:

• All non-formulary and restricted drugs require Prior Authorization for coverage
• All medications require 100% coinsurance until the member/family has met their deductible
• Once the deductible has been met, covered medications do not require a copay for the remainder of your benefit year
• Claims for medications at 100% coinsurance must be submitted to Unity from your pharmacy to count toward the deductible
  

No Unity Drug Coverage:

• Your employer may have purchased medical coverage through Unity, but not prescription drug coverage
• You may receive your prescription drug coverage through another organization
• Members covered under the State of Wisconsin health insurance program receive drug coverage through Navitus
• Badgercare Plus members need to contact the State Medicaid program at 800-362-3002 for their drug coverage

The best way to ensure that the prescriptions you receive are for covered formulary medications is to tell your practitioner that you are a Unity member before the prescriptions are written. Let your practitioner know that you would like formulary and/or generic medications if appropriate for treating your medical condition.

Pharmacy Benefit Links