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Pharmacy Coverage for UC Santa Cruz

Network Out-of-Network
SHC and Participating UC Pharmacies OptumRx Pharmacies All Other Pharmacies

SEPARATE LIMITS ON YOUR OUT-OF-POCKET COSTS

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

$3,000 individual/$6,000 family $6,000 individual/$12,000 family

Your share of prescription drug costs counts toward the combined annual medical/pharmacy out-of-pocket limit listed above. There are more details about the combined annual out-of-pocket limits in “My Medical Coverage.”

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 $60 specialty 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
  • 100% after $80 specialty copay, 30-day supply
  • $10 generic copay
  • $40 brand-name formulary copay, 30-day supply
  • $60 brand name non-formulary copay, 30-day supply
  • $80 specialty 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.