Pharmacy Information
Members with PAI’s pharmacy benefit coverage with OptumRx can use the drug cost estimator tool or use the pharmacy locator tool for broad network or view the drug lists below. For the most accurate and up-to-date information for all members, log into My Benefits ManagerSM, then PAI Pharmacy Benefits.
Understanding $0 Cost Share Prescription Drugs under the ACA
Covered drugs at $0 cost share" means prescription medications fully covered by your health plan, so you pay nothing out of pocket. This typically includes preventive medications required by the ACA, such as birth control, folic acid, aspirin, vaccines, and smoking cessation drugs.
Key Points:
- Preventive focus: Most drugs aim to maintain health and prevent disease.
- ACA compliance: Plans must cover these medications at no cost to you.
Examples:
- Generic oral contraceptives
- Folic acid supplements
- Low-dose aspirin
- Certain vaccines (e.g., HPV, Hepatitis B)
- Medications for tobacco cessation
Important Considerations:
- Check your plan: Coverage varies, so confirm which drugs are included.
- Generic vs. brand: Typically, only generic versions are covered.
- Consult your doctor: Ask your provider if you have questions about coverage.
List of Covered Drugs at $0 Cost Share, effective July 1, 2024