Pharmacy Benefits 2017-2018

Arizona Board of Regents Student Health Insurance Plan Pharmacy Benefits

Use Aetna Participating Pharmacies & present insurance ID card

UA Campus Health Service Pharmacy is a participating Pharmacy under the plan

Aetna’s on-line provider directory: www.aetnastudenthealth.com select “Find a Doctor or Hospital”

Preferred Care Policy Year Out-of-Pocket Maximum: Combined Medical & Pharmacy $1,500 (includes co-payments, deductible and co-insurance).

Policy Year Pharmacy Deductible: $125 (is waived at the UA Campus Health Service Pharmacy)

Prescription Co-pay Schedule

Generics: $ 15 co-pay

Brands Preferred: $40 co-pay

Brands Non-Preferred: $80 co-pay

Specialty Medication: $80 co-pay

Contraceptives

Generic contraceptive is covered at 100%

Important Note:  Brand-name contraceptive prescription drugs or devices from a preferred provider will be covered at 100% of the negotiated charge, including waiver of per policy year pharmacy deductible if a generic contraceptive prescription drug or device is not available in the same therapeutic drug class or the prescriber specifies dispense as written.