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Pharmacy Coverage for UC San Diego

Network
Out-of-Network
SHC OptumRx and Participating UC Pharmacies All Other Pharmacies
ANNUAL LIMIT ON YOUR OUT-OF-POCKET COSTS

Once you pay this amount toward your network and out-of-network covered prescriptions, UC SHIP steps in to pay 100% of your pharmacy costs.

$1,000 individual/$2,000 family; amounts count toward medical out-of-pocket maximum
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
  • 10% up to $100, 30-day supply
  • 100% after $10 generic copay
  • 100% after $40 brand-name formulary copay, 30-day supply
  • 100% after $100 brand-name non-formulary copay, 30-day supply
  • 10% up to $100, 30-day supply
  • $10 generic copay
  • $40 brand-name formulary copay, 30-day supply
  • $100 brand-name non-formulary copay, 30-day supply
  • 10% up to $100, 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.