Are prescriptions Eligible for Sharing?

Prescription medications (Rx) related to a new diagnosis are Eligible for Sharing with limitations.

Prescription medication expenses for prescribed drugs that may be dispensed, injected, or administered may be credited toward the PRA if they are not considered treatment for chronic conditions that were preexisting when the Member joined Impact.

After the Member’s PRA has been met, the prescription amount may be Shared as follows:

•After the first $25 on generic drug prescriptions.

•After the first $50 on brand name prescriptions when a generic is unavailable.

•Prescription medications must be purchased using the member ID card (see Rx information on the card).

•Members pay 100% of the (discounted) prescription amount at the pharmacy.

•Prescription drugs* that may be dispensed, injected or administered.

•Psychotropic medications and birth control expenses are not Eligible for Sharing.

The sharable amount is limited to $1200 per Member per membership year after the PRA has been met.

Exceptions may be made in the case of medications for cancer and transplant recipients.

For example, if the Member has met $1000 of their $2500 PRA and has a generic prescription that cost $55 and not for treatment of a preexisting condition, after paying $55 at the pharmacy, they may submit their bill and receive $30 credit ($55 -- $25) toward their PRA.

In the same example, if the Member has already met their PRA, then they may request that the $30 be Shared among Impact Members.

Note:

Pre-existing conditions do not apply to prescriptions for adults 65 and older with Medicare Parts A & B. Adults age 65 and older must have Medicare Part D for prescription costs to be Eligible for Sharing. (All sharing will be secondary to Medicare.)