If you are enrolled in PPO Medical Plan A or B, your prescription drug benefits are administered by MedImpact.
Starting January 1, 2026, your plan will include a manufacturer copay assistance program designed to help you save money and lower the overall cost of certain medications.
With full enrollment in the program, you could pay as little as $0 for qualifying prescriptions.
If you take a medication included in the program, enrolling in manufacturer copay assistance will reduce your copay.
What This Means for You
Members will need to use the Birdi mail-order pharmacy for certain high-cost maintenance medications. If this applies to you, you’ll receive a targeted letter from MedImpact in the weeks following this announcement. You’ll have up to four grace fills before Birdi becomes your required pharmacy for those medications.
Prevent gaps in your medication access—make the switch early.
Prescription Benefits
Currently, 75 FDA-approved prescription medications are covered through the benefits program. Important information regarding this prescription drug coverage is outlined below:
PPO Medical Plans A and B:
- Prescription drugs are administered through MedImpact using the “Select EX Formulary.”
- The MedImpact plan includes a five-tier prescription benefit. Tiered prescription drug plans require varying levels of payment depending on the drug’s tier and your copayment or coinsurance will be higher with a higher tier number.
- Tier 1 includes many generic drugs for high blood pressure, high cholesterol, depression, diabetes, and thyroid conditions.
- Tier 2 includes all other generic drugs. Generic drugs are required by the FDA to contain the same active ingredients as their brand-name counterparts.
- Tier 3 includes preferred brand-name drugs.
- Tier 4 includes non-preferred brand-name drugs.
- Tier 5 includes GLP-1 medications that treat obesity.
- If you purchase a brand name drug when there is a generic equivalent available, you will pay the brand copay plus the difference in cost between the brand name and the generic. Exceptions are available if the brand name medication is authorized as medically necessary by MedImpact.
- Up to a 90-day supply available at retail or through mail order.
- Maintenance medication refills are required to be dispensed in a 90-day supply by a pharmacy in the Rx90 network (Birdi Mail Order, Walgreens, or Costco retail pharmacy).
- Specialty medications must be filled by Birdi Specialty Pharmacy, with the exception of limited distribution drugs. For questions or to learn more, please visit MedImpact.com or call (877) 437-9012.
- Certain specialty medications are subject to a variable copayment. Birdi Specialty Pharmacy representatives will help you enroll in drug manufacturer assistance to reduce your out-of-pocket costs below the standard copayment tiers described above. If you are ineligible for the drug manufacturer assistance program, the standard copayment tiers apply.
- Certain non-specialty high-cost medications will have reduced copays by enrolling in manufacturer copay assistance and filling the medication at Birdi Mail Order.
- Discounts, coupons, or similar financial assistance provided by drug manufacturers or pharmacies to assist you in covering the cost of your medications (including any prescription drug discount/coupons provided to pharmacies when you fill a prescription) will not count against your annual deductible or maximum out-of-pocket limits. Only the amount that you pay separate and apart from the financial assistance will be credited as true out-of-pocket payment that will apply to your annual deductible and maximum out-of-pocket limits.
Enroll Today!
Sign up for BirdiRx Mail Order at BirdiRx.com to start home delivery of your maintenance medications before the effective date. You have 60 days from your first fill before the requirement begins.
Questions? Call MedImpact/BirdiRx Mail Customer Care at (866) 909-5170 (TTY: 711).
