INFORMATION ABOUT PHARMACY BENEFITS
You can learn about your pharmacy benefits by reviewing your Plan Document.
Pharmacy benefits are administered by AllumaTM. Alluma works with a vendor called Express Scripts® to provide certain services, such as the national pharmacy network. The amount you will pay will depend on the pharmacy you use to fill your prescription and the formulary status of the medication.
Formulary: Your plan follows the Alluma Advantage Formulary, which is developed by disease experts at Mayo Clinic.
Mail Service: Mayo Clinic Pharmacy Mail Service gives you the highest benefit level for glucose test strips, lancets, and insulin products.
Alluma pharmacy network: You have access to up to 64,000 pharmacies across the country.
Locate a network pharmacy: Use the online pharmacy search tool, available when you sign into your account at Medica.com/signin or in the Express Scripts mobile app.
No need to swing by the pharmacy to pick up your prescription refills. Sign up for Mayo Clinic Pharmacy Mail Service and your prescriptions will be delivered to your mailbox. You do not need to have a Mayo Clinic doctor to use Mayo Clinic Pharmacy Mail Service.
Getting started: You can register for service as a new patient using a form on the website. If you prefer to call customer service, the phone number is (800) 445-6326.
Refills: Once you have established service, you can order refills or update your credit card online, using the Mayo Clinic Portal.
New prescriptions: Your healthcare provider can send prescriptions electronically to Mayo Clinic Pharmacy – Mail Order. This is how the pharmacy is identified in the electronic medical record for prescribers. Pharmacy staff can assist with prescription transfers from another pharmacy.
Quantity allowed: Most prescriptions can be filled at Mayo Clinic Pharmacy Mail Service for up to a 102 day supply. You can order a refill after 75% of your prescription has been used up.
Plan ahead: Delivery can take up to 7-10 days if the pharmacy needs to call your provider for refills.
Payment: Mayo Clinic Pharmacy Mail Service accepts major credit cards including Visa, MasterCard, Discover or American Express.
Careful packaging: Your prescription will arrive in unmarked packaging. Most packages are sent via U.S. Postal Service. When needed, overnight delivery or temperature-controlled packaging are used to maintain medication quality. There are no shipping charges for regular delivery.
Savings programs: Check manufacturer websites for savings on brand name medications for medications like Ozempic®, Novolog®, or Baqsimi®. Provide the information you receive from the savings program to the pharmacy before your prescription is filled. Savings programs may significantly reduce the amount that you pay.
Quantity allowed: When filling a prescription at a retail pharmacy, your quantity will be limited to a 34-day supply. You can order a refill after 75% of your prescription has been used up.
Coinsurance: Base Plan members will pay a $10 copay for formulary generic prescriptions and $20 or 20%, whichever is greater, for formulary preferred medications. Non-preferred medications have a 50% coinsurance. HDHP plan members pay the above coinsurance once the deductible has been met.
Save money: City of Rochester pharmacy plan offers lower copays on insulin and blood glucose test strips if you fill through Mayo Clinic Pharmacy Mail Service.
Insulins may be filled for $10 copay for every 34-day supply dispensed up to a 102 day supply. Insulin syringes, pen needles, test strips, and lancets may also be filled for $10 copay for every 34-day supply dispensed up to 102-day supply.
Plan ahead: If you are not able to use the preferred insulins your doctor will need to request prior authorization. Please allow time for your request to be submitted and approved.
Save money: You may fill up to a 102-day supply on most blood sugar meters and testing supplies at Mayo Clinic Pharmacy Mail Service, or up to a 34-day supply at an Alluma network pharmacy. Mayo Clinic Pharmacy Mail Service will provide the lowest coinsurance or copay amount.
Preferred glucometers: Accu-Chek® and Contour® brand glucometers and test strips are covered by your health plan. The least expensive option will usually be the Accu- Chek Guide® glucose meter.
If you use insulin to manage your diabetes you may qualify for coverage of a continuous glucose monitoring (CGM) device, such as Dexcom® or FreeStyle Libre®.
Prior Authorization: Coverage of CGM requires prior authorization, so plan ahead if you are already on a CGM device. Your provider will need to submit a PA request to Alluma.
Pharmacy benefit coverage: FreeStyle Libre and Dexcom may be filled under the pharmacy benefit. FreeStyle Libre has a lower cost to you.
Medical benefit coverage: Medtronic GuardianTM is covered under the medical benefit. Please contact your medical benefits provider at the phone number on the back of your member ID card for questions about coverage.
We can help.
If you have any questions, you can call Alluma customer service 24 hours a day, 7 days a week at 800-818-9290. If you need expert advice from a clinical pharmacist, you can contact us here.