Legacy+
Employee Health Plan Information
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Pharmacy benefits
Advantages of getting prescriptions filled at Legacy Apothecaries
- Get a 90-day supply of medications for the cost of a 60-day supply
- Most specialty pharmacy medications will continue to be available through Legacy Apothecaries
Using Caremark pharmacies
- Most major pharmacy chains, including CVS, Walgreens, and Rite Aid, as well as many independent pharmacies, are in network. Check Caremark.com to ensure your pharmacy is in network
- Get up to a 90-day supply of maintenance medications at one time through retail pharmacies. (Prescriptions will need to reflect a 90-day supply.)
Weight loss drugs
- Weight loss drugs are not a covered benefit under the Legacy plans. Some manufacturers may provide a drug card to cover these prescriptions at a copay that does not run through your health plan. When these drug cards expire, the cost will be your responsibility.
Diabetic supplies
- Diabetic supplies, such as meters, continuous glucose monitors, lancets, needles, and syringes, will be covered under your pharmacy benefit.
- Some diabetic medications may no longer be on your drug list. Be sure to check the drug list to make sure your medication is still included. If your medication is no longer listed, please contact your doctor to discuss your options.
Things to remember
- Over-the-counter medications are no longer covered unless they are prescription strength and you have a prescription from your provider.
- A compound medication will only be covered if similar drugs on your drug list are not effective for you, and the prescription has received prior authorization.
- There will be a lifetime maximum applied to infertility medications. (You must meet a specified waiting period to be eligible for infertility benefits.)
Legacy+ Network
Your medical plans cover eligible services and supplies from Legacy+ network facilities for enrolled employees and dependents. All advanced imaging services must be provided at a Legacy Health facility. Please give this notice to your providers when seeking care: Legacy Employee Health Plan: Crucial Information for Providers
Out-of-network coverage is not covered except for:
- Medically necessary covered services not available through the Legacy+ Network*
- Urgent and Emergency Care
- Diabetic supplies (also available through CVS Caremark)
*Prior authorization from PacificSource is required before services are rendered.
Please note, there is not a benefit for out-of-network alternative care. You will need to go to in-network chiropractors, acupuncturists, massage therapists, and naturopaths in order to have these services covered under the plan.
Note about lab work
and imaging
If your provider is not a LabCorp laboratory provider and you need lab work, ask for a written order and take it to a laboratory to have your labs drawn and processed. You must also go to a Legacy facility for services such as mammograms, and all advanced imaging such as CT scans, MRIs, etc. Your provider may not be aware that out-of-network providers and facilities are NOT COVERED under your employee health plan.
Please give the notice, “Legacy Employee Health Plan: Crucial Information for Providers,” to your providers. This notice informs them about sending your advanced imaging referrals and so on to only in-network Legacy providers and facilities.
Mobile apps
The free myPacificSource and myPacificSource Admin (PSA) mobile apps let you manage your benefits, wherever you are.
myPacificSource app:
- Access your ID card, anytime.
- Find a provider, hospital, or urgent care center.
- Check your deductible and out-of-pocket totals.
myPacificSource Admin (PSA) app:
- Manage your FSA or other reimbursement accounts
Download the app today, and log in with your PSA account username and password.
Other prescription drug information
Enhanced Drug List offers top value
The Enhanced Drug List is now for everyone on the LEHP+ plan. The benefit allows certain drugs to be covered with a $5 copay. Most diabetic supplies are covered at 100%. This list is a separate benefit from preventive drugs covered under the Affordable Care Act.
Utilization Management
For certain prescription drugs, we have additional coverage requirements or limits. Learn more about utilization management, including prior authorization, quantity limits, and step therapy.
Affordable Care Act Standard Preventive No-cost Drug List (CVS Caremark)
The ACA Standard Preventive No-cost Drug List contains medications required by the government to be available at no cost to members of a health insurance plan. The list is maintained by CVS Caremark.
- The Apothecary–Legacy Mount Hood
24800 SE Stark
Gresham OR 97030
503-674-1597
Fax 503-674-1650 - The Apothecary–Legacy Emanuel
501 N Graham
Portland OR 97227
503-413-4225
Fax 503-413-4515 - The Apothecary–Legacy Good Samaritan
1040 NW 22nd Ave Suite 100
Portland OR 97210
503-413-8122
Fax 503-413-8453
- Legacy Meridian Park Community Pharmacy
19300 SW 65th Ave
Tualatin OR 97062
503-692-2662
Fax 503-692-7437 - Woodburn Pharmacy at Woodburn Health Center
1475 Mt Hood Ave
Woodburn OR 97071
971-983-5290
Fax 971-216-0090 - Legacy Apothecary-Legacy Salmon Creek
2121 NE 139TH St Suite 310
Vancouver WA 98686
360-487-3700
Fax 360-487-3709
Your pharmacy, dental, and vision benefits
Pharmacy Coverage
Need prescription drugs? Your pharmacy benefits are provided by PacificSource and CVS Caremark.
971-222-1050 (local Portland area, M-F, 7:00 a.m. to 5:00 p.m.)
844-520-5347 (toll-free)
Dental Plan
Your dental benefits are not through PacificSource, but are instead provided by Moda Health.
Portland:503-243-3886
Elsewhere:888-281-0405
Moda Health
More benefits
Doula program
Starting January 1, 2023, Legacy+ members may access a Legacy doula for personal, nonmedical support during pregnancy, labor and birth, and the postpartum period.
Click the button below to fill out a short form. Legacy will then match you with a doula who will make you feel safe, someone who will respect you, your family, and your birthing experience. We want you to feel positive about being a parent—whether it’s your first or fifth time!
Flexible Spending Account
Manage your FSA account from the convenience of your home, office or phone.
- View account information
- Submit a claim
- Update your personal information
- Change your direct deposit preferences
Download the MyPacificSource Admin app for iOS or Android to access your account on your mobile device.
Prior authorizations
Learn whether a procedure requires prior authorization. Visit our Provider Authorization Grid and then select "Legacy Employee Health Plan" from the left column to get started.
Documents and forms
Enhanced Drug List for Legacy Employees
Legacy Employee Health Plan: Crucial Information for Providers
Authorizations to use/disclose Protected Health Information (complete and sign both medical and FSA forms)
PacificSource Health Plans - Medical (Spanish)
PacificSource Administrators - FSA (Spanish)
Reimbursement forms
Claim Form - Medical and Rx (Spanish)
Care Coordination Request Form
Diabetic Supplies Claim Reimbursement Request Form (Spanish)
Flexible Spending Account (FSA) forms
FSA - Online Account Access for Participants Flier Please see this flier for instructions when signing in for the first time.
2025 FSA User Guide for Participants
General Purpose Health Flexible Spending Account (HRE) Eligible Expenses
FSA Reimbursement Request Form
Contacts
PacificSource Customer Service
(for medical, pharmacy, and FSA benefits)
971-222-1050 (local Portland area,
M-F, 7:00 a.m. to 5:00 p.m.)
844-520-5347 (toll-free)
LegacyEHP@PacificSource.com
COBRA
PacificSource Administrators
877-355-2760
Mail Payments to:
PacificSource Administrators
PO Box 2440
Omaha, NE 68103-2440