Prescription Drugs
Changes to Prescription Drug Coverage
Health care affordability continues to be a key priority for Boston University. Currently, GLP-1 weight-loss drugs are a major driver of increasing health care costs. To help align our health plan coverage strategy for all members of the BU Health Plans, GLP-1 medications for weight loss will no longer be covered effective January 1, 2026. Coverage for GLP-1 medications for type 2 diabetes will continue to be covered under the plan.
Your medical provider may be able to recommend alternative therapies if you are impacted by this change.
Prescription Drug Coverage
Prescription drug coverage is provided through OptumRx. When your doctor prescribes medication, you have choices about where and how the prescription is filled. There is a separate out-of-pocket maximum with the PPO Plan for prescription drug expenses of $2,500 for single coverage and $5,000 for family coverage.
The deductible and out-of-pocket maximum for the BU Health Savings Plan is applied to medical and prescription drug expenses.
If you are enrolled in the PPO Plan your out-of-pocket cost for prescription drugs depends on a few factors, as outlined below. If you are enrolled in the BU Health Savings Plan, your out-of-pocket cost for prescription drugs are based solely on the deductible, coinsurance, and prescription cost.
Expense |
Your Cost for Prescription Drugs in OptumRx Network |
|
BCBS PPO Plan |
BU Health Savings Plan |
|
Retail Pharmacy (30 day supply) |
|
|
| Generic | $10 copay | |
| Preferred Brand | 20% coinsurance ($45 minimum, $65 maximum) | |
| Non-preferred Brand | 30% coinsurance ($65 minimum, $85 maximum) | |
Mail Order & CVS Retail (90 day supply) |
||
| Generic | $20 copay | |
| Preferred Brand | 20% coinsurance ($85 minimum, $130 maximum) | |
| Non-preferred Brand | 30% coinsurance ($130 minimum, $170 maximum) | |
Deductible |
None |
Same deductible as any other medical expense $2,000 for single coverage $4,000 for family coverage |
Out-of-Pocket Maximum |
Separate maximum from medical expenses $2,500 for single coverage $5,000 for family coverage |
Same out-of-pocket maximum as any other medical expense $4,000 for single coverage $8,000 for family coverage |
Note: You pay 100% of cost of medications purchases outside the OptumRx network.
For additional questions, please contact the Human Resources Service Center at hr@bu.edu or 617-353-2380.