Your Unity Prescription Drug Benefit

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

$10/$20 DRUG (2 different dollar amounts indicate a two-tier drug benefit)
$10/$25 /$50 DRUG (3 different dollar amounts indicate a three-tier drug benefit)
DRUGS SUBJECT TO A $2,200 DEDUCTIBLE (this is a high-deductible HSA benefit)
NO UNITY DRUG COVERAGE (you don’t have a drug benefit through Unity, although you may have drug coverage through another entity such as Navitus)
SPEC RX $100 (the Specialty Pharmaceuticals Program is for certain medications that are subject to a $100 copayment per prescription)

If you have a Unity Prescription Drug Benefit, the Formulary indicates your copayment and whether the medication requires Prior Authorization.

Two-Tier Drug Benefits

Three-Tier Drug Benefits

Restricted drugs require Prior Authorization for coverage
Generic drugs require a Tier 1 copayment
Brand name drugs require a Tier 2 copayment
Non-formulary drugs require a Tier 3 copayment
Some drugs are covered only under the Specialty Pharmaceuticals Program and require a $100 copayment

High Deductible HSA Benefits

All non-formulary and restricted drugs require Prior Authorization for coverage
All medications require 100% coinsurance until the member or family deductible has been met
Once the deductible has been met, a copayment is not required for covered medications for the remainder of the benefit year
Your pharmacy must submit claims for medications charged at 100% coinsurance so that charges are counted 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 must contact the State Medicaid program at 800-362-3002 for information about their drug coverage

What's New?

Identifying Your Unity Drug Benefit What is the Drug Formulary? Obtaining Prior Authorization Rx90 Extended Supply Program Specialty Pharmaceuticals Program Half-Tab Program Step Therapy New Member Drug Supply Vacation Supply of Drugs Emergency Drug Supply Prescription Claim Form