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Pharmacy Coverage for UC Los Angeles

Network
Out-of-Network
The Ashe Center OptumRx Pharmacies All Other Pharmacies
SEPARATE LIMITS ON YOUR OUT-OF-POCKET COSTS

Once you pay this amount toward each category of covered prescriptions, UC SHIP steps in to pay 100% of your combined medical and pharmacy costs.

$2,000 individual/$4,000 family $3,000 individual/$6,000 family $6,000 individual/$12,000 family
Your share of prescription drug costs counts toward the combined medical/pharmacy annual out-of-pocket limit shown above. The Ashe Center pharmacy copay counts toward your UC Family annual out-of-pocket limit, offering you additional savings.
UC SHIP Covers

Outpatient Prescription Drugs

  • 100% after $5 generic copay
  • 100% after $25 brand-name formulary copay, 30-day supply
  • 100% after $40 brand-name non-formulary copay, 30-day supply
  • 100% after $10 generic copay
  • 100% after $40 brand-name formulary copay, 30-day supply
  • 100% after $60 brand-name non-formulary copay, 30-day supply
  • $10 generic copay
  • $40 brand-name formulary copay, 30-day supply
  • $60 brand-name non-formulary copay, 30-day supply
You pay any amount above the OptumRx maximum allowed amount.
 
Note: 100% with no copay for FDA-approved generic and brand-name (when no generic equivalent is available). Oral contraceptives are covered for up to 180-day supply.