The UIChoice plan covers outpatient drugs routinely prescribed for common acute and chronic conditions. The cost of prescription medication depends upon what tier the drug is in. To find out what tier your medication falls under visit Wellmark’s drug formulary.

Some complex medical conditions may require the use of special injectable medications. In these instances, arrangements have been made so that coverage will occur under the medical portion of your health plan rather than through the Prescription Drug Plan. Using a home infusion provider for injectable medications will allow for the least out-of-pocket expense when picking up the medications.

For each prescription, you will pay:
Tier 1: Generic formulary — FREE
Tier 2: Name brand formulary — 30%
Tier 3: Non-formulary — 50%

If a brand name drug is purchased when a generic equivalent is available, you are responsible for your coinsurance, plus any difference between the billed charge for the brand name drug and the billed charge for the generic. This can result in you paying substantially higher costs than if you had chosen the generic drug.

If your physician feels it is important for you to have the brand name drug instead of the generic equivalent, the physician can write a prescription for the brand name drug with the direction, "Dispense as written." In this situation you will not be responsible for the difference between the billed charge for the brand name drug and the billed charge for the generic drug.

The pharmacy is responsible for submitting your prescription claims.

There is a $1,100 per year out-of-pocket maximum (OPM) for individuals and $2,200 for families for prescription drugs under UIChoice.  Once the OPM has been met, the plan pays 100% of the expenses incurred for drugs during the rest of the calendar year. The OPM amount for prescription drugs is separate from the medical OPM.

Services Covered by the Prescription Drug Plan

• Prescription drugs (unless specifically excluded)
• Prenatal vitamins
• Prescription contraceptives and devices
• Prescription smoking cessation drugs
• Prescription drugs used as part of home health care services
• Insulin
• Disposable syringes and needles for the injection of insulin
• Glucose monitoring strips/lancets

Services Not Covered by the Prescription Drug Plan

• Prescription drugs received from a non-Blue RX pharmacy, except in an emergency or when temporarily living out of Iowa
• Most over-the-counter drugs
• Therapeutic devices and appliances, except disposable syringes and needles for the injection of insulin
• Nutritional supplements, including vitamins (except for prenatal vitamins)
• Investigational drugs labeled "Caution: Limited by Federal Law to Investigational use"
• Drugs not medically necessary for the treatment or prevention of illness, injury, or other covered condition
• Drugs used for cosmetic purposes (e.g., tretinoin (Retin-A) for treatment of skin aging, minoxidil (Rogaine) for stimulation of hair growth)
• Drugs dispensed by a person authorized to prescribe drugs (e.g., physicians, dentists and advanced registered nurse practitioners.)
• Drugs obtained outside the United States
• Charges for drugs covered by Worker's Compensation laws or other federal, state, or county programs