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We invite you to call or visit us today: Samaritan Health Plans, 815 NW 9th Street,
Corvallis OR 97330, M-F, 8a.m. to 5 p.m.
(541) 768-6900
(800) 569-4616
Pharmacy benefits and services
This is only a brief summary of benefits. Please refer to your Plan Document for a further explanation of benefits, including limitations and exclusions.
| 2008 Prescription Drug Benefit - Full-Time | |||
| Therapeutic | Generic | Preferred | Non- Preferred |
| $0 for 7 specified generic drugs* | $5 | $15 | >$50 or 50%, plus** |
| 2008 Prescription Drug Benefit - Part-Time/Retiree | |||
| Therapeutic | Generic | Preferred | Non- Preferred |
| $0 for 7 specified generic drugs* | $10 | 20% | >$50 or 50%, plus** |
Samaritan Select mail order benefit
Mail order is an optional method of obtaining maintenance medication under this prescription plan. Not all prescription medications are available from the mail order supplier and mail order benefits are available only when prescriptions are dispensed and the claim is submitted electronically on-line by the mail order supplier. See Mail Order Prescriptions for instructions on how to access and use this service.
Co-pays listed below are for a 90-day supply.
| 2008 MAIL-ORDER Prescription Drug Benefit (90-day supply) - Full-Time | |||
| Therapeutic | Generic | Preferred | Non- Preferred |
| $0 for 7 specified generic drugs* | $12.50 | $37.50 | >$125 or 50%, plus** |
| 2008 MAIL-ORDER Prescription Drug Benefit (90-day supply) - Part-Time/Retirees | |||
| Therapeutic | Generic | Preferred | Non- Preferred |
| $0 for 7 specified generic drugs* | $25.00 | $62.50 | >$125 plus** |
*Enalapril and lisinopril for high blood pressure; lovastatin and simvastatin (generic Zocor) for high cholesterol; glipizide, glyburide and metformin for diabetes
**Plus the difference between generic and brand for multisource brands. Multisource brand—a brand where there is an exact generic equivalent available.
