Prescription Drug
All of Samsung’s medical plans automatically include prescription drug coverage. If you enroll in a UHC medical plan, prescription drug coverage is provided by CVS Caremark. If you enroll in the Kaiser HMO, prescription drug coverage is provided by Kaiser.
Understanding your prescription drug coverage
Types of prescription drugs
The amount you pay for prescriptions depends on the type of drug:
- Tier 1: Lowest cost option and typically covers generic drugs and the lowest cost brand name drugs.
- Tier 2: Mid-range cost option and covers most preferred brand name drugs.
- Tier 3: Highest cost option and covers drugs that are usually the newest and most expensive, and are considered non-preferred brand name drugs.
Visit CVS Caremark or Kaiser to view a list of covered medications.
Prescription drug programs for UHC medical plans
Specialty medications through PrudentRx
PrudentRx administers the specialty drug copay program.
If you’re enrolled in an HDHP plan, you must meet your deductible before you’ll have no copay for specialty medications.
Call 1-800-578-4403 to participate. If you have questions, email info@prudentrx.com.
Important: If your doctor prescribes a specialty medication that’s eligible for the PrudentRx copay assistance program, CVS/PrudentRx will contact you about enrolling in the program. If you enroll, your copay will be $0. If you don’t want to participate in the program, your copay will be 30%.
Compare prescription drug costs
In-Network
| UHC Base HSA Plan (HDHP) | UHC Buy-Up HSA (HDHP) | UHC Choice Plus Copay Plan (PPO) |
Kaiser HMO CA Only1 |
|
|---|---|---|---|---|
| UHC Base HSA Plan (HDHP) | UHC Buy-Up HSA (HDHP) | UHC Choice Plus Copay Plan (PPO) |
Kaiser HMO CA Only1 |
|
| Preventive – Retail | ||||
| Preventive | Covered at 100% See the preventive drug list |
No coverage | ||
| Up to 30-Day Supply – Retail | ||||
| Tier 1 | $10 copay after deductible |
$10 copay | $10 copay | |
| Tier 2 | $30 copay after deductible |
$30 copay | $20 copay | |
| Tier 3 | $50 copay after deductible |
$50 copay | n/a | |
| 90-Day Supply – Mail Order | ||||
| Tier 1 | $15 copay after deductible |
$15 copay | $20 copay | |
| Tier 2 | $45 copay after deductible |
$45 copay | $40 copay | |
| Tier 3 | $75 copay after deductible |
$75 copay | n/a | |
1 Mail order through Kaiser provides a 100-day supply.
Out-of-Network
| UHC Base HSA Plan (HDHP) | UHC Buy-Up HSA (HDHP) | UHC Choice Plus Copay Plan (PPO) |
Kaiser HMO CA Only1 |
|
|---|---|---|---|---|
| UHC Base HSA Plan (HDHP) | UHC Buy-Up HSA (HDHP) | UHC Choice Plus Copay Plan (PPO) |
Kaiser HMO CA Only1 |
|
| Preventive – Retail | ||||
| Preventive | Covered at 100% See the preventive drug list |
No coverage | ||
| Up to 30-Day Supply – Retail | ||||
| Tier 1 | $10 copay after deductible |
$10 copay | No coverage | |
| Tier 2 | $30 copay after deductible |
$30 copay | ||
| Tier 3 | $50 copay after deductible |
$50 copay | ||
| 90-Day Supply – Mail Order | ||||
| Tier 1 | $15 copay after deductible |
$15 copay | No coverage | |
| Tier 2 | $45 copay after deductible |
$45 copay | ||
| Tier 3 | $75 copay after deductible |
$75 copay | ||
1 Mail order through Kaiser provides a 100-day supply.
Contact
UHC medical plan
Use the CVS Pharmacy Locator to search for in-network pharmacies.
CVS Caremark
- caremark.com
- 1-866-477-1664
- Plan#: 717584
Kaiser HMO
In-network pharmacies are located in Kaiser Permanente hospitals and medical offices.
- kp.org
- 1-800-464-4000
- Plan #: 605540
Locate in the microsite here: https://yoursamsungbenefits.com/physical-health/prescription-drug/