Prescription Drug Program
Prescription Drug coverage is provided as part of your health care coverage. The plan includes a three-tier copayment structure, meaning that you pay a copay based on whether your prescription is a generic drug, a brand name formulary drug or a non-formulary brand name drug. A formulary is simply a list of preferred drugs used by the health care plan. You may choose to purchase a 30-day supply of your prescription at a retail pharmacy. Or, if you require a maintenance drug, you can opt to use the mail-order service to receive up to a 90-day supply. Express Scripts Mail Order Form (PDF)
Express Scripts, Inc. (ESI) is our Plan's pharmacy benefits and mail order manager, whose goal is to keep drugs safer and more affordable. You may call 1-800-752-0598 for additional information or questions regarding your prescription drug benefits.
Please keep in mind that Generic Drugs are a safe, low-cost alternative to your brand-name prescription medications. Over the last 18 months, use of generics amongst our members increased by about 5% and produced a savings of over $1.1 million. Besides the benefits to the plan, you can benefit personally as generics can save you up to 80% on out-of-pocket copays. We ask you to help us to continue to control prescription drug costs by considering generics as an alternative to brand name drugs. And you can do this with total confidence. The FDA mandates that generic drugs be chemically equivalent to their brand name counterparts. This means that generic drugs contain the same active ingredients, will act the same in your body, in the same amount of time, and be as effective to treat your medical conditions. The FDA carefully oversees generic drugs to ensure their safety and effectiveness.
2008 Prescription Drug Program
Network Retail:
Tier 1: $5 (No Deductible)
Tier 2: $25(No Deductible)
Tier 3: 30% or $45, whichever is greater (No Deductible)
Network Retail when Medicare Part B is primary:
Tier 1: $3 (No Deductible)
Tier 2: $18(No Deductible)
Tier 3: 30%or $35, whichever is greater (No Deductible)
Network Mail Order:
Tier 1: $10(No Deductible)
Tier 2: $50 (No Deductible)
Tier 3: 30%or $90, whichever is greater (No Deductible)
Network Mail Order when Medicare Part B is primary:
Tier 1: $6(No Deductible)
Tier 2: $30 (No Deductible)
Tier 3: 30%or $45, whichever is greater (No Deductible)
Note: If there is no generic equivalent available, you will still have to pay the Tier 2 copay.When purchasing drugs at a pharmacy, you must use your Health Insurance Card
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Specialty pharmacy: 5% coinsurance, up to a maximum of $150 per drug/per 30 day supply
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