Its a PEBBle
Under group number 15993, what is the drug deductible?
$100
Under the group number 16370, what is the formulary number?
25008GP
Under the MAPD plan with riders, what is the formulary name?
25Group H Full Edit
What is the pharmacy network for group number 15704?
Broad + WAG90
Under group number 15994, does the cost of prescription that fall under the ACA drug list apply toward the deductible?
No
What is the pharmacy network for the plan under group number 16370?
Broad + CVS90
What is the cost for covered medications that treat Erectile Dysfunction for the MAPD plan with riders?
50% cost share
Do step therapy/quantity limits/prior authorization listed on RxWeb apply for plan under group number 15704?
Yes
Under group number 15994, what is the cost sharing for foreign Rx claims?
Tiers cost share is $45 copay per 30-day supply
Under group number 16370, are retirees allowed to utilize non Optum mail order?
No
Under the MAPD plan with riders, what rule applies to the maximum out-of-pocket for prescription coverage?
$1,000 Out-of-Pocket Max applies to Mail Order Rx (Part D and bonus drugs) only.
What limitations apply to Tier 4 drugs under the plan with group number 15704?
Tier 4 Specialty Drugs are Limited to 31 Day Supply for both Retail and Mail Order.
Under 15994, what is the cost share for one month of Simvastatin 40mg in a retail pharmacy?
$0.00
Which tiers apply toward the drug deductible for the plan under group number 16370?
T2, T3, T4
What is the name of the custom bonus drug list?
2025 CalPERS custom benefit List
What is the cost share for insulin syringes under the plan with group number 15704?
The GRIFs reference a custom drug list for $0 Part D Diabetic Supplies.
Under 15994, what is the cost share for one month of NOVOLOG FLEXPEN in a retail pharmacy?
$10.00 copy
What does pharmacy network CVS90 mean?
Retirees can use CVS retail pharmacies for increased member savings.
What is the cost share for Sildenafil tab 50mg under the MAPD plan with riders?
50% cost share
What does pharmacy network WAG90 mean?
Retirees can use Walgreens retail pharmacies for increased member savings