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Mutual of Omaha Rx
Value
Value
Mutual of Omaha Rx
Plus
Plus
$27.00
premium/month
$44.80
premium/month
| Starting with a low monthly premium, our Value plan delivers affordable coverage and a $0 deductible for tier 1-2 drugs. | Our Plus plan is our basic plan that covers a broad choice of prescriptions while offering low-cost generic drug choices. |
Deductible |
Deductible |
|
$0
Tiers 1 & 2 $415
Tiers 3 - 5 |
$415 |
Preferred Network |
Preferred Network |
| CVS, CVS/Target, Walmart, Sam's Club, and regional Rx networks. | CVS, CVS/Target, Walmart, Sam's Club, and regional Rx networks. |
| This plan works best for the cost conscious, healthy population. | This plan works best for people that take multiple medications. |
Cost Share by Tier and Network
| Preferred Retail 30 Days |
Standard Retail 30 Days |
Preferred Home Delivery 90 Days |
||||
|---|---|---|---|---|---|---|
|
Tier 1: Preferred Generic*
These are the most commonly prescribed and affordable prescriptions.
|
$1 | $5 | $2 | $3 | $8 | $8 |
|
Tier 2: Generic*
These are a little more expensive than Tier 1, but still generic medicines.
|
$4 | $10 | $8 | $5 | $13 | $15 |
|
Tier 3: Preferred Brand*
Tier 3 drugs are brand-name or higher-priced generic prescriptions.
|
15% | 18% | 18% | $30 | $45 | $100 |
|
Tier 4: Non-Preferred Brand*
These are more expensive brand-name drugs.
|
37% | 40% | 40% | 48% | 50% | 48% |
|
Tier 5: Specialty*
These are the most expensive drugs. They treat very complex conditions like cancer.
|
25% | 25% | 25% | 25% | 25% | 25% |
|
Tier 1: Preferred Generic*
These are the most commonly prescribed and affordable prescriptions.
|
||||||
|
Preferred Retail 30 Days |
$1 | $3 | ||||
|
Standard Retail 30 Days |
$5 | $8 | ||||
|
Preferred Home Delivery 90 Days |
$2 | $8 | ||||
|
Tier 2: Generic*
These are a little more expensive than Tier 1, but still generic medicines.
|
||||||
|
Preferred Retail 30 Days |
$4 | $5 | ||||
|
Standard Retail 30 Days |
$10 | $13 | ||||
|
Preferred Home Delivery 90 Days |
$8 | $15 | ||||
|
Tier 3: Preferred Brand*
Tier 3 drugs are brand-name or higher-priced generic prescriptions.
|
||||||
|
Preferred Retail 30 Days |
15% | $30 | ||||
|
Standard Retail 30 Days |
18% | $45 | ||||
|
Preferred Home Delivery 90 Days |
18% | $100 | ||||
|
Tier 4: Non-Preferred Brand*
These are more expensive brand-name drugs.
|
||||||
|
Preferred Retail 30 Days |
37% | 48% | ||||
|
Standard Retail 30 Days |
40% | 50% | ||||
|
Preferred Home Delivery 90 Days |
40% | 48% | ||||
|
Tier 5: Specialty*
These are the most expensive drugs. They treat very complex conditions like cancer.
|
||||||
|
Preferred Retail 30 Days |
25% | 25% | ||||
|
Standard Retail 30 Days |
25% | 25% | ||||
|
Preferred Home Delivery 90 Days |
25% | 25% | ||||
*The copay and cost-sharing depends on where you get your prescription filled.
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