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Announcing advantage90, a new program designed to save you time and money

University Health Plan Prescription Drug Benefit Summary
Effective: January 1, 2012
Administered by: CatalystRx (formerly Walgreens Health Initiatives, Inc.)
The University Health Plan Prescription Drug Benefit Program is administered by CatalystRx. The information
below is not a guarantee of benefits and may be subject to change. If there is any discrepancy between this
information and any other legal documents governing the plan, the legal documents govern.
For questions concerning your pharmacy benefits (for example, copay, eligibility or location of a nearby
participating pharmacy), call the CatalystRx Customer Care Center toll-free, 24 hours a day, 7 days a week
at:
1-800-207-2568
Your Cost
When your covered prescriptions are filled under this program, you share a portion of the cost. The plan pays for
the rest. Your costs for the program are as follows:
Retail Pharmacy (short-term medications):
Retail Pharmacy (long-term medications)*:
Prescriptions written for up to 30-day supply Prescriptions written for a 90-day supply (Advantage90™) Accutane, Acne (topical), Atopic Dermatitis, Accutane, Acne (topical), Atopic Dermatitis, COX-2 Inhibitors, Effexor XR, Lamisil/Sporanox, COX-2 Inhibitors, Effexor XR, Lamisil/Sporanox, Lexapro, Non-Sedating Antihistamines, Prevacid & Lexapro, Non-Sedating Antihistamines, Prevacid &
* Only available at select retail pharmacies. See list of pharmacies participating in Advantage90™ 90-day retail
program.
** A covered prescription for a “preventive health service” will have a $0.00 copayment and will not be subject to
any deductible.
It is standard pharmacy practice (and in some states required by law) to substitute generic equivalents for brand-
name drugs whenever possible. Under the Plan, whenever a brand-name drug is dispensed when a generic
substitute is available and allowable, you will be responsible for the brand copayment plus the difference
between the brand and generic price of each drug.

Covered Drugs
Federal legend drugs (that is, drugs that federal law prohibits dispensing without a prescription) Drugs Not Covered
Hair loss treatments (for example minoxidil, Propecia ®)
This is a partial listing of drugs which are covered and drugs not covered. Certain prescriptions may require
pre-authorization.
For specific drug inquiries, contact the CatalystRx Customer Care Center at 1-800-207-2568.
Participating Pharmacies
Covered Individuals can choose from more than 60,000 participating pharmacies. Below are just some of the
many pharmacies participating in the CatalystRx retail network. For additional participating pharmacies, call the
CatalystRx Customer Care Center at 1-800-207-2568.
NOTE: The University Health Plan prescription drug program does not include a mail order option. All
prescriptions must be filled through a retail pharmacy.

Albertsons *

* Pharmacies participating in Advantage90™ 90-day retail program.
CatalystRx Cards
Within 10–14 days of enrollment, Covered Individuals will receive CatalystRx cards via mail. Covered
Individuals
must present their CatalystRx card when covered prescriptions are filled under this program
(see sample cards below).
The RxBIN# for the UHP retail prescription plan is 603286. The RxGRP# is 514619. The PCN# is 01410000.

Source: http://slunews.com/Documents/medicine/UHP_Pharmacy_Benefits_Jan_2012.pdf

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