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 & POS) | 30-Day Minimum (POS only) | 30-Day Maximum (HSA & POS) |
|---|---|---|---|
| Zero- Preventative | 0% | $0.00 | $0.00 |
| 1- Generic | 10% | $10.00 | $25.00 |
| 2- Prefered Brand | 20% | $30.00 | $75.00 |
| 3- Non-Prefered Brand | 30% | $60.00 | $120.00 |
| 4- Lifestyle | 40% | $90.00 | $150.00 |
| 5- Select | 40% | 40% co-insurance (no minimum or maximum) | |
Tools & Resources
Visit Prime Therapeutics website beginning October 5, 2026 to check medication coverage and cost or find an in-network Prime Therapeutics pharmacy.
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. Unlike many plans that are dropping GLP-1 coverage altogether, the Emory Health Plan will continue to provide coverage for GLP-1 medications for eligible members.
Coverage details, including eligibility requirements and member cost sharing, will be available before Open Enrollment.
Yes. The Emory Health Plan will introduce Tier 5 coverage for members using GLP-1 medications for non-diabetes indications. This tier will include a 40% member coinsurance responsibility.
While this represents a higher out-of-pocket cost for some members, it is significantly less than members would pay if coverage for these medications were eliminated from the formulary entirely.
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.