Pharmacy Benefits
Pharmacy Benefits
Easy and affordable prescriptions for as little as $4

How it works

  • Pharmacy benefits are automatically included in all medical plans.
  • Preventive medications are covered with fixed copays and no deductible
  • If you use a non-network pharmacy you’ll pay the full retail price of the medication

 

Other plan details

  • With most plans, you must fill your prescriptions at a Walmart or Sam's Club pharmacy or by mail order to pay as little as $4 for generic drugs—unless you work more than five miles from one of these pharmacies*.
  • With the Local Plans or Select Local Plan, you must use a Walmart or Sam’s Club pharmacy. There is no exception based on distance to a pharmacy.
  • With the eCommerce PPO Plan, you can use any Aetna network pharmacy.
  • If you're enrolled in the Premier Plan or Contribution Plan, you can purchase eligible prescriptions by paying the copays shown below. Funds in your HRA account cannot be used to purchase prescriptions.
  • If you're enrolled in the Saver Plan, you’ll pay the full retail price for eligible prescriptions until you meet your annual deductible. After that, you pay the copays listed in the chart below. Many preventive medications are covered at the copays shown below before you meet your deductible.
  • If you're enrolled in the Premier Plan, Contribution, Saver Plan, Local Plans, or the Select Local Plan, the money you pay for eligible prescriptions counts toward your annual out-of-pocket maximum.
  • All specialty drugs under the Premier Plan, Contribution, Saver Plan, Local Plans, and Select Local Plan must be purchased through a Walmart Specialty Pharmacy or OptumRx. 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 to inquire about the availability of your prescription drugs under the plan.

 

  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** 25% of allowed cost** $30
Specialty drugs 20% of allowed cost** 20% of allowed cost** after deductible $60

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

Retail and mail-order prescriptions

Retail and mail-order prescriptions: Each retail copay covers up to a 30-day supply of an eligible prescription (unless otherwise noted). A 90-day supply of mail-order drugs is three times the cost of a 30-day supply purchased at retail pharmacies.
 

What's covered? 

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

Certain brand-name and other prescription drugs are not 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. Here are a few of the most common:

  • Proton Pump Inhibitors are excluded from coverage. Proton Pump Inhibitors are drugs like Nexium, used for GERD or acid reflux. You can purchase these drugs over the counter (OTC).
  • Non-sedating antihistamines are excluded from coverage. Non-sedating antihistamines are drugs like Zyrtec, used for allergies. You can purchase these drugs OTC.
  • Brand-name statins are excluded from coverage. Statins are drugs like Lipitor, used to control cholesterol. Prescription generic statins are covered.
  • Brand-name angiotensin receptor blockers (ARBs) are excluded from coverage. ARBs are drugs like Cozaar, used to control high blood pressure. Prescription generic ARBs are covered.
  • Brand-name hypnotics are excluded from coverage. Hypnotics are drugs like Xanax, for anxiety disorders, and Lunesta, used as a sleep aid. Prescription generic hypnotics are covered. Step therapy will be available when generic fails. Step therapy will allow brand-name drug coverage in approved cases.
  • Brand-name migraine medication is excluded from coverage. Migraine drugs like Imitrex are used to treat migraine headaches. Prescription generic migraine medication is covered. Step therapy will be available when generic fails. Step therapy will allow brand-name drug coverage in approved cases.
  • Brand-name opioids are excluded from coverage. Brand-name opioids are narcotic drugs like Vicodin, used to treat pain. Prescription generic opioids are covered, though they may only be filled for seven days each time. Step therapy is available when generic fails. Step therapy allows brand-name drug coverage in approved cases.
  • Growth hormones: There is only one brand available. All others are excluded from coverage. Step therapy will be available when a preferred brand fails.

 

*If you enroll in any Walmart medical plan option, you must use a Walmart or Sam's Club pharmacy to receive a pharmacy benefit. All other pharmacies are considered out-of-network, and you'll pay the full retail price. If there is no Walmart or Sam's Club pharmacy within five miles of your work location, you'll also be able to use your benefit at any OptumRx network pharmacy—unless you enroll in the Select Local Plan or Local Plans. For the eComm PPO Plan, you need to use Aetna network pharmacies.

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

2019 Pharmacy Benefits

In 2020 Express Scripts will be replaced by OptumRX, which will handle all your prescription needs.

  • The 2019 formulary—the list of drugs that are covered by your plan—is different from the 2020 version. You’ll find the 2019 formulary on the Express Scripts website.

Other than these changes, all the other information on this page applies to your current coverage.

For complete details about the 2019 plan, see the 2018 Associate Benefits Book with 2019 Summary of Material Modifications.