Prescriptions

Have questions about your prescription coverage?

Learn about your benefits, costs, formulary lists and any coverage restrictions by contacting your Pharmacy Benefit Manager (PBM) listed below.

If you prefer talking with a HealthEZ representative, call 1-844-855-0615

Filling prescriptions.

EHiM Rx is your pharmacy benefit manager (PBM).

Your pharmacy information is listed on the back of your medical ID card.

Bring your ID card with you when filling all prescriptions to be sure the pharmacy has current coverage information.

To speak to an EHiM Rx Customer Care Representative, please call 1-800-311-3446 24 hours a day

To send an EHiM Rx Customer Care Representative a message, click here.

Visit the EHiM Rx website here.

Forms

PPO Benefit Booklet	Provides a high level overview of your prescription benefits with EHiM.
HSA Benefit Booklet	Provides a high level overview of your prescription benefits with EHiM.
PPACA Formulary	Provides a list of preventive care drugs covered at a $0 copay.
Mail Service Overview	Provides a high level overview of your prescription mail service with EHiM.
Mail Service Order Form	Mail Service Registration & Prescription Order Form.
Generic Drug Facts	Provides a list of Frequently Asked Questions about generic drugs.
Medicare Part D Notice	This notice has information about your current prescription drug coverage and about your options under Medicare’s prescription drug coverage.

Prescription Drug Coverage

	Retail 30 Day Suppy	Mail Order 90 Day Supply
Copay Plan - Written by Lake Superior Community Health Providers
Generic	$10 Copay	$20 Copay
Preferred Brand	$15 Copay	$30 Copay
Non-Preferred Brand	$30 Copay	$60 Copay
Specialty	$50 Copay	Not Available
Copay Plan - Written by all other Providers
Generic	$12 Copay	$24 Copay
Preferred Brand	$50 Copay	$100 Copay
Non-Preferred Brand	$90 Copay	$180 Copay
Specialty	20% up to $200	Not Available
*After deductible
High Deductible Plan - Written by Lake Superior Community Health Providers
Generic	$10 Copay*	$20 Copay*
Preferred Brand	$15 Copay*	$30 Copay*
Non-Preferred Brand	$30 Copay*	$600 Copay*
Specialty	$50 Copay*	Not Available
*After deductible
High Deductible Plan - Written by all other Providers
Generic	$12 Copay*	$24 Copay*
Preferred Brand	$50 Copay*	$100 Copay*
Non-Preferred Brand	$90 Copay	$180 Copay*
Specialty	20%* up to $200	Not Available
*After deductible

Did you know there are coupon and price comparison sites for prescriptions?

Check out these sites and see if you are paying too much.