Local Pharmacy
Save up to 15% on brands and up to 55% on generic drugs at the retail provider location.
Health Innovations assures members and their immediate family the lowest price on their prescription needs. The Health Innovations membership card is welcomed at approximately 52,000 pharmacies nationwide and will save members up to 55%. Members simply present their card to their local participating pharmacy in their area, the pharmacy will enter their usual and customary price into the on-line computer, and the member will receive the contracted discount price or the usual and customary price, whichever is lowest. On occasion, a pharmacy may price popular prescriptions below their wholesale cost as a "loss leader". When that happens, the network members are guaranteed to receive the lower of the two prices. Our pharmacy network includes a wide variety of national chains as well as thousands of independent pharmacies.

How the Program Works:

1. Members present their Health Innovations membership card along with their prescription upon arrival to a participating provider. If the member has had previous coverage under another plan they should inform the pharmacy to update their profile so that claim will be transmitted under the correct program.
2. The pharmacy will then enter the prescription information that is being purchased along with their usual and customary price for the prescription. They will then enter the member's 9-digit identification number and 8-digit carrier group number into the AdvancePCS on line adjudication system. The AdvancePCS system calculates the preferred pricing for the medication and electronically relays this information to the pharmacist.
3. The member pays the preferred price at the time of service.

For medications taken on a daily basis for blood pressure, arthritis, heart conditions, etc., our mail order pharmacy described below may save the member the most money.

Mail Order Pharmacy
Save up to 19% on brands and up to 60% on generic drugs through our mail order service.
Members receive maximum savings on maintenance prescriptions through our mail service prescription drug program. This provides our members a dramatically cost-efficient way to purchase a 30-90 day supply of maintenance drugs with three refills at greatly reduced prices. Administered by a leader in the wholesale mail-order prescription business, this guarantees the member the quality of name brands (or generic substitute) members use everyday. All prescriptions are checked for accuracy. Our dispensing system screens the Patient Profile for drug interactions or incompatibilities, and checks for potential drug allergies, side effects or other concerns. Orders are shipped within 48 hours of receipt and customer satisfaction is our highest priority.

AdvancePCS Plan Discounts:
Average Wholesale Price (AWP) - 13% + $3.50 dispensing fee: The Average Wholesale Price for a prescription is the generally accepted price for a prescription in the region.

Maximum Allowable Cost (MAC) + $3.50 dispensing fee: Cost containment program created to reduce program costs for members. Specific to generic equivalents of drugs, it sets a ceiling on the highest unit price to be paid for a drug. AdvancePCS has developed their own MAC lists, which consists of 713 generic prescriptions.

Usual and Customary Price (UNC): This is the pharmacies normal retail price for the prescription for the member. Please note that if a pharmacy were doing a price match or a senior citizen price that price would be entered as their UNC price.

Prescription Monitoring:
The AdvancePCS pharmacy program includes a special prescription monitoring service called drug utilization review (DUR). The process electronically alerts the pharmacists to important information such as the member's individual drug history, the possibilities of interaction among various drugs and how long it has been since the members last prescription was filled. If the potential for drug-related illness exists, an alert message is sent to the pharmacists. The pharmacists can then inform the member to check with their doctor or they can make a professional judgment whether to dispense the prescription or not.

Covered Drugs:

• Legend drugs- drugs that cannot legally be obtained without a physician's prescription
• Insulin
• Disposable needle/syringes
• Disposable blood/urine glucose/acetone testing agents
• Lancets- a sharp pointed and commonly 2 edged surgical instrument used to make small incisions
• Compound medications of which at least one ingredient is a legend drug
• Any other drugs, which under the applicable state law, may only be dispensed upon the written prescription of a physician or other lawful prescriber.
• Legend contraceptives

Drug Exclusions:

• Anti-wrinkle agents
• Growth hormones
• Immunization agents, blood or blood plasma
• Levonorgestrel
• Minoxidil (Rogaine) for the treatment of alopecia
• Non-legend drugs other than those listed above
• Therapeutic devices or appliances, including support garments and other non-medicinal substances, regardless of intended use, except those listed above.
• Charges for the administration of injection of any drug.
• Drugs labeled "Caution-limited by federal law to investigational use" or experimental drugs, even though charges are made to the individual.
• Medication which is to be taken or administered to an individual, in whole or in part, while he or she is a patient in a licensed hospital, rest home, sanitarium, extended care facility, convalescent hospital, nursing home or similar institution which operates on its premises, or allows to be operated on its premises, a facility for dispensing pharmaceuticals.

Please note:
The AdvancePCS program cannot be used in combination with other discount programs. The AdvancePCS card can be used in combination with certain types of traditional insurance and members would present their AdvancePCS membership to the pharmacy upon arrival and pay the network price at the time of service. Then member should file a claim form with their traditional insurance plan.