The Trust’s four-tier therapeutically based prescription plan is designed to promote the use of proven, cost-effective medications. Costs are the same for both in- and out-of-network.

• Find a pharmacy

Tier 0—Some highly cost-effective medications: Co-pay per 30-day supply $0

• Cholesterol Lowering Medications (Simvastatin)
• Proton Pump Inhibitors (Prilosec OTC, with physician prescription)
• Non-sedating Antihistamines: Generic Claritin (Loratadine and Loratadine D)
• Metformin
• Lancets

Tier 1—Current generics, some future generics: Co-pay per 30-day supply: $6 for generics on Group Health Options formulary.

Tier 2—Most brand drugs, and more costly or less desirable future generics: Co-pay per 30-day supply: $22 for brand on Group Health Options formulary.

Tier 3—Generic or brand name drugs not on the Group Health Options formulary: Co-pay per 30-day supply: $35.

Mail Order:
Co-pays for a 90 day supply listed below. (Must use Group Health Mail Order Program)

• Tier 0 - $0
• Tier 1 - $18 for generic if on Group Health Options formulary
• Tier 2 - $66 for brand if on Group Health Options formulary
• Tier 3 - $70 if not on Group Health Options formulary (brand or generic)
• Brand Name Drug with Generic Available - Generic co-pay plus the actual difference in cost between the generic and the brand name drug

• Download Group Health mail order form

Look to your benefits booklets for more information.

Find the details of your prescription drug coverage in your Summary Plan Description (choose the link below based on whether you are in the “Sound” or “SoundPlus” plan).

• Sound Plan Group Health Option Summary Plan Description (including 1/1/11 Benefit Changes)
• SoundPlus Plan Group Health Option Summary Plan Description (including 1/1/11 Benefit Changes)
• Eligible Dependent Children Definition

$0 Co-Pay Flu and Pneumonia Shots

Getting a flu or pneumonia shot is just as convenient as ever. Eligible Sound Health & Wellness Trust Group Health Options plan participants and their dependents can receive $0 co-pay flu and pneumonia shots at Group Health medical centers.

Getting a flu shot is the single best way to protect against the flu. Children from 6 months to 19 years of age, pregnant women, people 50 and older, and people with certain chronic medical conditions are especially encouraged to get a flu shot. People aged 65 and older or those with chronic illnesses or compromised immune systems are highly encouraged to also get a pneumonia shot.