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.
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)