Prescription Coverage

This self-insured Plan has adopted a Prescription Savings Program along with a prescription formulary identifying drugs that the Plan may consider for payment at participating pharmacies.

MedBen RX Member Prescription Portal - To register visit MBAccess.MedBen.com and click on the “First time here? Register” link located in the home page. Select Participant/Insured and follow the steps to create your user name and password. Once registered you can click on the “View Rx Claims” icon.

The Plan has expanded coverage to include MedBenRx's Benefit Preservation Program. This program incorporates the use of Patient Assistance Programs and/or copay assistance coupons for eligible members. Questions about the program can be directed to help@benefitspreservationprogram.com or 1.877.393.0009.

Prescription Savings Program

Prescription Savings Program Brochure

The Prescription Savings Program combines quality medical care for ongoing, routine treatment with a low copay for prescription medications: up to a 90-day supply* for $5. The Program is available to primary Plan members and does not coordinate benefits with other insurance coverage.

To utilize the Prescription Savings Program, the member must transfer primary care services to the Wood County Community Health Center.

To ensure the effectiveness of a medication, any prescription for a new medication will be limited to a 30-day fill. After that, a 90-day fill will be available with the exception of any prescription over $1,000. Those are limited to a 30-day fill. Note that not all medications are available through this program.

Call the Benefits Line at 419.354.1373 with questions regarding the program or email benefits@woodcountyohio.gov.

*Some restrictions apply.

Compare DRUG Pricing

Excluded & Limited Services

Request for Medical Necessity Review

Coverage for Excluded and Limited Services may be authorized and approved by the Medical Manager and/or Plan based on Medical Necessity and other Plan design features. Approval is required prior to Plan payment. Refer to the Plan Document for the list of excluded and limited services. Note that any drug over $1,000 is subject to prior approval before dispensing and must go through the medical necessity review process.

Prior to purchase, the prescribing physician and employee shall complete a Medical Necessity Review form and submit to the Plan for consideration. Insufficient or incomplete information may result in a delay or denial of the claim.

If approved by the Medical Manager, the Plan will notify the Subscriber of the effective dates of coverage and any other limitations. In some cases, coverage may be limited to a 30-day supply. The Plan reserves the right to direct site of care.

Copay with Prescription Savings Program:
$5 for 90-day supply*

Copay at Retail Pharmacy:
$20 plus 50% of the TCC maximum $200 out-of-pocket

Select Over-The-Counter

The following Over-the-Counter (OTC) drugs are available under the Plan with a valid prescription.

Gastrointestinal - Esomeprazole OTC, omeprazole OTC, lansoprazole OTC, famotidine OTC, omeprazole w sodium bicarbonate capsules OTC

Sinus/Allergy - cetirizine OTC, cetirizine liquid OTC, loratadine, OTC, loratadine syrup, fluticasone nasal spray OTC, triamcinolone nasal spray OTC

Cold Sores - Abreva Cream

Eye Allergy - ketotifen

Medicare Part D

Wood County has determined that this prescription drug coverage is, on average for all Plan participants, expected to pay out as much as the standard Medicare prescription drug coverage pays and is considered Creditable Coverage. You can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan. You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15 to December 7. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two month Special Enrollment Period (SEP) to join a Medicare drug plan. For more information about Medicare Prescription Drug Coverage visit www.medicare.gov or 1.800.Medicare or refer to the Plan Document.