Health Plan Prescription FAQs

  1. Is there a separate deductible for the prescription drug program?

    Yes. The deductible for the prescription drug program is separate from the deductibles under other sections of the Plan such as hospital and major medical. The prescription drug deductible applies to the retail pharmacy program, Express Scripts by Mail and Accredo, Express Scripts' specialty pharmacy.
  2. What is the co-payment under the prescription drug program?

    When you use Express Scripts by Mail, your co-payment is the greater of the following two amounts (90 day supply):
    Generic: $20 or 10%; maximum co-pay of $50 per Rx
    Preferred brand drug: $50 or 25%; maximum co-pay of $125 per Rx
    Non-preferred brand drug: $100 or 40%; maximum co-pay of $300 per Rx

    When you use the retail pharmacy, your co-payment is the greater of the following two amounts (30 day supply):
    Generic: $10 or 10%
    Preferred brand drug: $25 or 25%
    Non-preferred brand drug: $40 or 40%

    The Plan will not vary the co-payment according to whether your physician writes "Dispensed as Written" (DAW) on your prescription.
  3. How do I use Express Scripts Home Delivery Service?

    Obtain a prescription for up to a 90-day supply of medication from your doctor, complete a Express Scripts Home Delivery Service form and send it, along with the applicable co-payment, to Express Scripts Home Delivery Service P.O. Box 747000 Cincinnati, OH 45274-7000. Express Scripts Home Delivery Service forms are available at Express Scripts and from the Plan Office.
  4. How do I get reimbursed for compounded medications?

    Send your itemized receipt, along with an Express Scripts reimbursement form, to Express Scripts Attn: Commercial Claims P.O. Box 2872 Clinton, IA 52733-2872. Express Scripts Reimbursement forms are available on our Web site under Health Forms, at Express Scripts and from the Plan Office.
  5. With the deductible and coinsurance at the mail service pharmacy, how will I know how much to send in with my prescription?

    You can call Express Scripts' toll free membership services department at (800) 903-4728 or you can log on to their web site at www.express-scripts.com and use the Coverage & Pricing calculator.
  6. My doctor says I must use a brand name drug and cannot use the generic version. Why is my co-payment higher?

    The Plan simply cannot afford to provide brand name drugs for a minimal co-payment, particularly when generic alternatives exist. Since brand name drugs cost significantly more than their generic counterparts, you will be asked to share in this higher cost
  7. How are prescription co-payments calculated?

    Prescription Drug Plan
    Effective January 1, 2012
    Retail Network Pharmacy Express Scripts Home Delivery Service
    (formerly referred to as mail service)
    Days Supply Up to 30 days
    per prescription and/or refill
    Up to 90 days
    per prescription and/or refill
    Deductible (per calendar year)
    Applies to drugs purchased at both a retail network pharmacy and through Express Scripts Home Delivery Service.
    $150 per individual/$300 per family $150 per individual/$300 per family
    Generic drugs $10 or 10% of the prescription drug's total cost,
    whichever is greater
    $20 or 10% of the prescription drug's total cost,
    whichever is greater;
    maximum co-payment is $50 per prescription
    Preferred brand drug $25 or 25% of the prescription drug's total cost,
    whichever is greater
    $50 or 25% of the prescription drug's total cost,
    whichever is greater;
    maximum co-payment is $125 per prescription
    Non-preferred brand drug

    $40 or 40% of the prescription drug's total cost, whichever is greater

    $100 or 40% of the prescription drug's total cost, whichever is greater; maximum co-payment is $300 per prescription

  8. How can I save money by using generics when possible?

    Following are some examples of how you can save money by using generics whenever possible instead of name-brand drugs:

    Medication name

    Retail - 30 Day supply/ quantity of 30

    Mail - 90 days supply / quantity of 90

    Approximate cost

    Co-pay

    Approximate cost

    Co-pay

    Zantac 150MG - Brand

    $123.07

    $123.07

    $330.00

    $300.00

    Rantidine 150MG - Generic

    $6.22

    $6.22

    $5.20

    $5.20

    Prozac 20MG - Brand

    $204.85

    $204.85

    $551.40

    $300.00

    Fluoxetine 20MG - Generic

    $6.62

    $6.62

    $9.90

    $9.90

    Prinivil 10MG - Brand

    34.11

    $34.11

    89.17

    $89.17

    Lisinopril 10MG - Generic

    $7.41

    $7.41

    $1.83

    $1.83

    The above examples assume that the prescription drug deductible has been satisfied.