Pharmacy Benefits
Prescription Drug Coverage
If you’re enrolled in a Bloomin’ Brands medical plan, you also have coverage for prescription drugs through Express Scripts. Refer to the information below to learn about how your prescriptions will be covered under your medical plan.
Plan Comparison
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| Choice HSA, Value HSA & Choice HRA | Value HRA | |||
|---|---|---|---|---|
| Retail pharmacy (30-day supply) | Express Scripts mail order service, Smart90 Walgreens, or CVS | Retail pharmacy (30-day supply) | Express Scripts mail order service, Smart90 Walgreens, or CVS | |
| Medical plan deductible applies | Yes | (90-day supply) | Yes | (90-day supply) |
| Generic | After deducible is met, 20% up to a $20 max | After deductible is met, 20% with a $30 min up to $60 max | After deductible is met, 0% | After deductible is met, 0% |
| Preferred brand | After deductible is met, 20% with a $35 min and $100 max | After deductible is met, 20% with a $105 min and $300 max | After deductible is met, 0% | After deductible is met, 0% |
| Non-preferred brand | After deductible is met, 40% | After deductible is met, 0% | After deductible is met, 0% | After deductible is met, 0% |
Helpful Terms & Definitions
Prior Authorization
Some medications won’t be covered unless you receive pre-approval. You may need approval for coverage of the drug or for coverage of additional quantities of a drug. Medications may fall under one or more programs. You can contact Express Scripts to determine if the medication you’re prescribed requires pre-approval.
Step Therapy
This requires you to first try one or more specified drugs to treat a particular condition before the plan will cover another (usually more expensive) drug that your doctor may have prescribed. Step therapy is intended to reduce costs to you and your plan by encouraging use of medications that are less expensive but can still treat your condition effectively.
Drug Quantity Management
Aligns the dispensed quantity of prescription medication with dosage guidelines approved by the Food and Drug Administration (FDA) or clinical evidence.
Formulary
The National Preferred Formulary, Express Scripts’ standard formulary, preserves individual choice and access to clinically effective generic and brand-name drugs. The formulary includes nearly 100% of generics and more than 4,000 unique products.
Coverage Review
For prescriptions that need pre-approval, you, your doctor, or your pharmacist may initiate the review by calling Express Scripts at 1-800-753-2851.
Network
Smart90 Exclusive requires members to fill their maintenance medications at a Smart90 retailer, Walgreens, or through our home delivery pharmacy, and at a 90-day supply.
Vaccines
The plan offers convenient access to vaccines from local retail pharmacies.
Prescription Drug Coverage
If you’re enrolled in a Bloomin’ Brands medical plan, you also have coverage for prescription drugs through Express Scripts. Refer to the information below to learn about how your prescriptions will be covered under your medical plan.
New for 2025
- The prescription drug program will no longer require maintenance medications to be filled at Walgreens or CVS. You can fill prescriptions for a 90-day supply of maintenance medications through the Express Scripts mail order program or at any network pharmacy starting Jan. 1, 2025.
- All plans now cover preventive medications at 100%.
- Plans will be integrated with GoodRx, automatically providing discounted pricing at the pharmacy when it is available.
Pharmacy Coverage Comparison
| New Value PPO | New Choice PPO | Choice HSA | Value HRA | Choice HRA | Value HSA | |
|---|---|---|---|---|---|---|
| Generic Prescription Drugs | $10 copay | $10 copay | 20% after deductible | 0% after deductible | 20% after deductible | 20% after deductible |
| Preferred Brand Prescription Drugs | 20% after deductible | $30 copay | 20% after deductible | 0% after deductible | 20% after deductible | 20% after deductible |
| Non-Preferred Brand Prescription Drugs | 40% after deductible | $50 copay | 40% after deductible | 0% after deductible | 40% after deductible | 40% after deductible |
Helpful Terms & Definitions
Prior Authorization
Some medications won’t be covered unless you receive pre-approval. You may need approval for coverage of the drug or for coverage of additional quantities of a drug. Medications may fall under one or more programs. You can contact Express Scripts to determine if the medication you’re prescribed requires pre-approval.
Step Therapy
This requires you to first try one or more specified drugs to treat a particular condition before the plan will cover another (usually more expensive) drug that your doctor may have prescribed. Step therapy is intended to reduce costs to you and your plan by encouraging use of medications that are less expensive but can still treat your condition effectively.
Drug Quantity Management
Aligns the dispensed quantity of prescription medication with dosage guidelines approved by the Food and Drug Administration (FDA) or clinical evidence.
Formulary
The National Preferred Formulary, Express Scripts’ standard formulary, preserves individual choice and access to clinically effective generic and brand-name drugs. The formulary includes nearly 100% of generics and more than 4,000 unique products.
Coverage Review
For prescriptions that need pre-approval, you, your doctor, or your pharmacist may initiate the review by calling Express Scripts at 1-800-753-2851.
Network
Smart90 Exclusive requires members to fill their maintenance medications at a Smart90 retailer, Walgreens, or through our home delivery pharmacy, and at a 90-day supply.
Vaccines
The plan offers convenient access to vaccines from local retail pharmacies.
More Resources
Pre-Enrollment Tool
You can use the Express Scripts pre-enrollment tool to search for pharmacies, look up prescription drug pricing, and more.
Get the Express Scripts App
The Express Scripts app is available for Apple and Android devices. With the app, you can:
- Manage your prescriptions and order refills from your phone.
- Display your virtual ID card at the pharmacy.
- Receive personalized alerts to help ensure you are following your treatment plan.
- Find potential lower-cost prescription options and discuss them with your doctor.
- View your prescriptions, set reminders, and receive notifications when your medication is running low.
