Pharmacy Benefits
Beginning January 1, 2027 Prime Therapeutics will manage pharmacy benefits for the HSA and POS plans, replacing CVS/Caremark.
- You will continue to have access to major retail pharmacies continues, including CVS, Walgreens, Publix, Kroger, Walmart, and Costco, as well as Emory in-house pharmacies.
- Pharmacy options will expand to include home delivery through Amazon Pharmacy, with expedited delivery available for eligible medications and locations.
- The pharmacy formulary is changing, but most members will see no change in medication coverage or cost. If your medications are affected, you will be notified before your new coverage begins.
Pharmacy Benefits Cost and Coverage
HSA Plan
If you are enrolled in the HSA Plan, you pay the full cost of prescription drugs until you meet your annual deductible, except for Tier Zero preventive and chronic care medications, which are covered at 100% by Emory Health Plan with a $0 member cost. You may use your HSA funds to help pay for eligible prescription drug expenses.
After you meet your deductible, you pay the applicable coinsurance amount for covered prescription drugs, up to the retail maximum shown in the chart below. For example, if your coinsurance is 20%, the plan pays 80% of the covered drug cost and you pay 20%, up to the applicable maximum.
POS Plan
With the POS Plan, you do not need to meet a deductible before prescription drug benefits apply. Tier Zero preventive and chronic care medications are covered at 100%. For other covered prescription drugs, you pay coinsurance within a six-tier structure, subject to the retail minimum and retail maximum shown in the chart below. This means your cost is based on a percentage of the drug’s cost, but it will not be less than the minimum or more than the maximum for that tier.
| Tier | Co-Insurance (HSA and POS) | 30-Day Minimum (POS only) | 30-Day Maximum (HSA and POS) |
|---|---|---|---|
| Zero – Preventative | 0% | $0.00 | $0.00 |
| 1 – Generic | 10% | $10.00 | $25.00 |
| 2 – Preferred Brand | 20% | $30.00 | $75.00 |
| 3 – Non-Preferred Brand | 30% | $60.00 | $120.00 |
| 4 – Lifestyle | 40% | $90.00 | $150.00 |
| 5 – Select | 40% | 40% co-insurance (no minimum copay and maximum of $200 for 30-day supply) | |
Tools & Resources
Visit Prime Therapeutics website to check medication coverage and cost or find an in-network Prime Therapeutics pharmacy
Emory Health Plan Medication List (Formulary Guide)
2027 Tier Zero Preventive Prescription Drug List for Emory Health Plan HSA and POS Members
Pharmacy Benefits FAQs
Prime Therapeutics helps manage pharmacy benefits when members fill a prescription. This includes covered medications, participating pharmacies, and prescription support.
Beginning January 1, 2027, Prime Therapeutics will also manage the plan’s updated list of preferred medications. If a medication is affected, members will be notified in advance of the new plan year and supported in understanding covered options.
Emory Specialty Pharmacy helps coordinate specialty medication support across providers and care teams, creating a more connected experience throughout treatment.
This means members can receive personalized support for complex and specialty medications, expert guidance throughout treatment, assistance with medication approvals and refills, better coordination among healthcare providers and care teams, and a more connected and convenient healthcare experience.
Yes. The Emory Health Plan will continue to provide coverage for select medications used for weight management and related conditions, including GLP-1 medications, for eligible members in accordance with the plan's clinical guidelines.
Beginning in 2027, certain medications in this category will be covered under a new Tier 5.
Yes. Beginning in 2027, the Emory Health Plan will introduce Tier 5 – Select for certain medications, including GLP-1 medications used for weight management and related conditions. Medications covered under Tier 5 – Select will have a 40% member coinsurance responsibility up to a maximum of $200 per 30-day supply.
While this represents a higher out-of-pocket cost for some members than they may pay today, Emory will continue providing coverage for these medications rather than eliminating coverage altogether.
This change helps balance continued access to select medications with the long-term affordability and sustainability of the health plan for all employees and their families.
GLP-1 medications have become an important treatment option for many patients, but they also represent one of the fastest-growing healthcare costs nationwide.
Emory remains committed to providing access to clinically appropriate medication and treatments while responsibly managing healthcare costs so the health plan remains affordable and sustainable for all employees and families.