Pharmacy Benefits

Bloomin' Benefits 5 Benefits 5 Medical Coverage 5 Pharmacy Benefits
Heads up! This information reflects the current 2024 plan year, which ends Dec. 31.

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 HRAValue HRA
Retail pharmacy (30-day supply)Express Scripts mail order service, Smart90 Walgreens, or CVSRetail pharmacy (30-day supply)Express Scripts mail order service, Smart90 Walgreens, or CVS
Medical plan deductible appliesYes(90-day supply)Yes(90-day supply)
GenericAfter deducible is met, 20% up to a $20 maxAfter deductible is met, 20% with a $30 min up to $60 maxAfter deductible is met, 0%After deductible is met, 0%
Preferred brandAfter deductible is met, 20% with a $35 min and $100 maxAfter deductible is met, 20% with a $105 min and $300 maxAfter deductible is met, 0%After deductible is met, 0%
Non-preferred brandAfter 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.

Heads up! This information reflects the new 2025 plan year, which begins Jan. 1.

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 HSAValue HRAChoice HRAValue HSA
Generic Prescription Drugs: 30-Day Supply$10 copay$10 copay20% after
deductible
0% after deductible20% after deductible20% after deductible
Preferred Brand Prescription Drugs: 30-Day Supply20% after
deductible
$30 copay20% after
deductible
0% after deductible20% after deductible20% after deductible
Non-Preferred Brand Prescription Drugs: 30-Day Supply40% after
deductible
$50 copay40% after
deductible
0% after deductible40% after deductible40% after deductible
Generic Maintenance Medications: 90-Day Supply$10 copay$25 copay20% after
deductible
0% after deductible20% after deductible20% after deductible
Preferred Brand Maintenance Medications: 90-Day Supply20% after
deductible
$75 copay20% after
deductible
0% after deductible20% after deductible20% after deductible
Non-Preferred Brand Maintenance Medications: 90-Day Supply40% after
deductible
$125 copay40% after
deductible
0% after deductible40% after deductible40% 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.
Express Scripts

Express Scripts

Pharmacy

Contact Information

Phone: 1-866-725-2520

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