Pharmacy Benefits
Easy and affordable prescriptions for as little as $4.
All our medical plans include pharmacy benefits, with low-cost generics available at Walmart and Sam’s Club pharmacies.

Prescriptions you can afford.

$4_generics

$4 generics
 

Generic prescription
medications are available
for just $4.

Preventive__care

Preventive care
 

Preventive medications are
covered with fixed copays, with
no deductible required.

Network_only

Network only
 

With most plans, you’ll pay full price
if you use a pharmacy other than
Walmart or Sam’s Club.

Walmart or Sam’s Club only — with exceptions

If you’re in the Premier, Contribution, Saver, or a Local Plan, you must use a Walmart or Sam's Club pharmacy to get your pharmacy benefit. All other pharmacies are considered out-of-network, and in most cases you'll pay the full retail price.

If there isn’t a Walmart or Sam's Club pharmacy within five miles of where you work, you'll also be able to use your benefit at any OptumRx network pharmacy unless you’re enrolled in a Local Plan.

What plans are included?
  • Premier, Contribution, and all Local Plans: The benefits shown here are automatically included.
  • Saver Plan: Due to IRS rules, you must pay full price for most care until you meet your annual deductible. After that, you’ll get the benefits shown here. However, you can get some preventive medications for just a copay without meeting your deductible.
  • eComm PPO Plan: Prescriptions start at $10 for generic drugs, as shown below. In this plan, you can use any Aetna pharmacy.
  • HMO plans: All HMOs include prescription benefits, which typically start at $10 for generic drugs. Ask your People Partner or contact your plan directly for details.
What drugs are covered?

To be eligible, drugs must be on Walmart's formulary list . This list is maintained by OptumRx. It’s reviewed quarterly and often changes. You can also call OptumRx at 844-705-7493 to ask about a particular drug. For the eComm PPO, you'll find the formulary here: www.aetnapharmacy.com/premier.

 

Some brand-name and other prescription drugs aren’t covered because generic or over-the-counter alternatives have proven to be just as effective. You’ll find a complete list in the 2020 Associate Benefits Book with 2021 Summary of Material Modifications. Here are a few of the most common:

  • Proton pump inhibitors are drugs like Nexium, used for GERD or acid reflux. They aren’t covered because they can be bought over the counter (OTC).
  • Non-sedating antihistamines are allergy drugs like Zyrtec. They aren’t covered because they can be bought OTC.
  • Brand-name statins like Lipitor are used to control cholesterol. Generic versions of these drugs are covered.
  • Brand-name angiotensin receptor blockers (ARBs) are drugs like Cozaar, used to control high blood pressure. Generic versions of ARBs are covered.
  • Brand-name hypnotics are drugs like Xanax, for anxiety disorders, and Lunesta, used as a sleep aid. Generic versions of hypnotics are covered. Step therapy will be available if the generic doesn’t work and will allow brand-name drug coverage in approved cases.
  • Brand-name migraine drugs like Imitrex are used to treat migraine headaches. Generic versions of migraine medications are covered. Step therapy will be available if the generic doesn’t work and will allow brand-name drug coverage in approved cases.
  • Brand-name opioids are narcotic drugs like Vicodin, used to treat pain. Generic versions of opioids are covered, though they may only be filled for seven days each time. Step therapy is available if the generic doesn’t work and will allow brand-name drug coverage in approved cases.
  • Growth hormones: There is only one brand of growth hormone available. All others are excluded from coverage. Step therapy will be available if a preferred brand doesn’t work.
Mail order

When you pick up a prescription at a Walmart or Sam’s Club pharmacy, each copay covers up to a 30-day supply. If your take a medication regularly and order it by mail, you’ll pay three times this cost and receive a 90-day supply.

Specialty drugs

All specialty drugs under the Premier, Contribution, Saver, and Local Plans must be purchased through a Walmart Specialty Pharmacy or OptumRx Specialty Pharmacy. If a specialty drug is purchased from another retail pharmacy, it will not be covered under the plan. You should call a Walmart Specialty Pharmacy or OptumRx Specialty Pharmacy to ask about the availability of your prescription drugs under the plan.

Medicare coverage

If you’ll be eligible for Medicare soon, you should know that Walmart's prescription drug benefit has been determined to be “creditable coverage” as defined by Medicare, except for the Saver Plan. That means that on average it's expected to pay as much as, or more than, a standard Medicare drug plan.

 

If you later decide to join a Medicare drug plan, having “creditable coverage” under the Walmart plan will keep you from paying a higher premium under Medicare. For more information, see the Medicare Part D notice (PDF).


Here’s your cost for prescriptions, depending on the plan you choose. Each copay covers up to a 30-day supply.

  Premier Plan, Contribution Plan, Select Local Plan, Local Plan Saver Plan eComm PPO
Generic drugs $4 copay $4 copay after deductible $10
Brand-name drugs* 25% of allowed cost* or $50, whichever is greater 25% of allowed cost* or $50, whichever is greater $30
Specialty drugs 20% of allowed cost* or $50, whichever is greater 20% of allowed cost* or $50, whichever is greater, after deductible $60

*The allowed cost of prescription drugs is determined by the plan’s pharmacy benefit manager.

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