New Pharmacy Benefits Manager Effective January 1, 2026

Starting January 1, 2026, Liviniti will serve as the new Pharmacy Benefits Manager (PBM) for all Pelican and Magnolia plans, including the Pelican HSA 775 plan.

Liviniti will manage your prescription drug benefits, including pharmacy networks, covered medications, and prescription claims.

SilverScript will continue to provide prescription drug coverage for members enrolled in Medicare and offers a nationwide network of pharmacies. SilverScript plan benefits will remain the same for 2026 for plan member and their covered dependents on Medicare enrolled in:

• Magnolia Local
• Magnolia Local Plus
• Magnolia Open Access
• Pelican HRA 1000

To find a pharmacy, the cost of a prescription drug, or to see if a drug is in the SilverScript Network or SilverScript/CMS formulary, please click below: https://info.caremark.com/oe/ogbmedicarerx.

PHARMACY BENEFITS – PELICAN & MAGNOLIA PLANS

These plans utilize the Liviniti formulary for active and retired individuals without Medicare, and SilverScript for retirees with Medicare. The formulary is reviewed regularly to reassess drug tiers based on the current prescription drug market. Members will continue to pay a portion of the cost of their prescriptions in the form of a co-pay or coinsurance. The amount members pay toward their prescription depends on whether or not they receive a generic, preferred brand, non-preferred brand or specialty drug.

Tier

Member Co-Pay*

Generic

50% up to $30

Preferred

50% up to $55

Non-Preferred

65% up to $80

Specialty

50% up to $80

Once you pay $1,500:

Generic

$0

Preferred

$20

Non-Preferred

$40

Specialty

$40

*Member responsibility is for a prescription drug benefit of up to a 31-day supply.

PHARMACY BENEFITS – PELICAN HSA775

Members enrolled in the Pelican HSA will not have a pharmacy out of pocket threshold to meet; however prescriptions are subject to the plan deductible with the exception of maintenance medications.

Tier

Member Co-Pay*

Generic

$10

Preferred

$25

Non-Preferred

$50

Specialty

$50

*Subject to deductible and applicable co-payment. Maintenance drugs are not subject to the deductible.

Click on the 2026 Pelican HSA 775 Maintenance/Preventive Card Drug List for more information on the pharmacy benefits through Liviniti.


PHARMACY RESOURCES

Liviniti

Liviniti Customer Service

1-833-925-2770

24/7 Member Service Support

Microsite.liviniti.com

2026 Pelican HSA 775 Maintenance/Preventive Card Drug List

OGB Member Welcome Flyer

OGB Member Reference Guide

Manual Claim Reimbursement Form

OGB Member Frequently Asked Questions (FAQ)

OGB Mobile App – Tools to manage prescriptions, find pharmacies, and access benefit information on the go

Liviniti Formulary

Liviniti OGB Disease Management List

Liviniti OGB 2026 ACA Preventive List

PA Appeals Policy

Liviniti Sample Membership Card

SilverScript

1-888-996-0104

24 hours/7 Member Service Support

Silverscript Member Website (www.info.caremark.com/oe/ogbmedicarerx)

1-866-693-4620

Pharmacy Help Desk

1-888-472-1159 Fax Number

Physician/Member

2026 SilverScript Formulary

CVS/Caremark Prescription Claim Form

SilverScript Medicare Part D Prescription Claim Form

SilverScript Benefits for Medicare Retirees

2025 High Income Irma Surcharge Verification Form

Caremark Diabetic Meter for SilverScript Members