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LGHP Prescription Plan
Plan participants enrolled in any LGHP health plan have prescription drug benefits included in the coverage. All prescription medications are compiled on a preferred drug list ("formulary list") maintained by each health plan's prescription benefit manager (PBM). Formulary lists categorize drugs in four levels: Reduced Tier 1, Tier1, Tier 2, and Tier 3 brands. Each level has a different copayment amount. Coverage for specific drugs may vary depending upon the health plan. It is important to note that formulary lists are subject to change at any time during the plan year. To compare formulary lists, cost-savings programs and to obtain a list of pharmacies that participate in the various health plan networks, plan participants should visit the website of each health plan they are considering.
Plan participants who have additional prescription drug coverage, including Medicare, should contact their plan’s PBM for coordination of benefits (COB) information.
Plan participants enrolled in HealthLink OAP, Aetna OAP, BlueCross BlueShield of IL OAP, Local Consumer-Driven Health Plan (LCDHP) or the Local Care Health Plan (LCHP), have CVS/caremark as their PBM.
Under the Affordable Care Act, Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs, will be covered by the plan without cost-sharing requirements.
FY2025 LGHP Prescription Copayments
| Reduced Tier I* | Tier I | Tier II | Tier III | Specialty Tier | ||
| HMOs | 30-day Supply | $4.00 | $15.00 | $30.00 | $60.00 | $120.00 |
| 90-day Supply | $10.00 | $37.50 | $75.00 | $150.00 | $350.00 | |
| OAPs |
30-day supply |
- |
$15.00 |
$30.00 |
$60.00 |
$120.00 |
| 90-day supply |
- |
$30.00 |
$60.00 |
$120.00 |
- | |
| **90-day Maintenance Choice |
- |
$15.00 |
$30.00 |
$60.00 |
- | |
| |
||||||
| LCHP |
30-day supply |
- |
$15.00 |
$30.00 |
$60.00 |
$120.00 |
| 90-day supply |
- |
$30.00 |
$60.00 |
$120.00 |
$240.00 | |
| **90-day Maintenance Choice
|
- |
$15.00 |
$30.00 |
$60.00 |
- | |
| LCDHP | Copayments (30-day supply) | - | 70%; Deductible applies | 50%; Deductible applies | 50%; Deductible applies | - |
| Maintenance Choice (90-day supply)** | - | 85%; Deductible applies | 75%; Deductible applies | 75%; Deductible applies | - | |
* Applies to specific medications as defined by plan
** Medications received at CVS Caremark® Pharmacy or through CVS Caremark® Mail Service Pharmacy.
Prescription Vacation Override Process (For the Self-Insured Plans only)
Local Government (LG) employees and their covered dependents that are actively enrolled in the LG’s OAP, LCHP or LCDHP health plans are eligible for 2 Prescription Vacation Overrides per year.
Employees and/or their covered dependents going on vacation or an extended stay outside of the United States, who require an early refill or who will need medications to cover a period greater than the current prescription refill, must request an exception for a Prescription Vacation Override for that time period. This form Prescription Vacation Override Request needs to be filled out in its entirety and sent to the email/physical address at the bottom of the form.
Note: If you are enrolled in a LG - HMO health plan you will need to contact your health insurance carrier to obtain information on their process for this type of request.