What you pay
|Retail pharmacy |
|Express Scripts mail order service or Smart90 Walgreens
|Medical plan deductible applies||Yes|
|Generic||After deducible is met, 20% up to a $20 max||After deductible is met, 20% with a $30 min up to $60 max|
|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|
|Non-preferred brand||40% after deductible|
|Contraceptives — generic||Covered in full|
|Preventive — generic & preferred||Covered in full on the My Health Savings Plan only|
To check how your prescriptions will be covered under the Choice HRA and the My HSA Plan, visit the Express Scripts pre-enrollment website.
Download the Express Scripts app
With the free mobile 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.
Not all drugs in a medication class will be subject to prior authorization. Certain medication classes require pre-authorization prior to fill. They are:
- Androgens and Anabolic Steroids (PA)
- Cystic fibrosis
- Dermatologicals — Tretinoins/Tazorac (all dosage forms)
- Bone conditions
- Oncology medications
- Smoking deterrents
Note: Additional medications may require pre-authorization prior to fill.
If you use pain (narcotic) or sleep disorder medications and the dosage prescribed exceeds FDA-approved levels, your prescription will be subject to prior authorization. This precaution is designed to address safety concerns with these drugs.
If you are prescribed an oral cancer medication, genetic testing at no charge to you may be offered to confirm you will metabolize the drug properly and to insure no resistance or immunity to the drug. In addition, pre-authorization will confirm the drug use is aligned with FDA approvals and is being properly administered.
For medication you need on an ongoing basis — called maintenance medications — you have two ways to get up to a 90-day supply.
You can conveniently fill these prescriptions either through the Express Scripts Pharmacy (home delivery) OR from any Walgreens pharmacy. Examples of conditions commonly requiring ongoing medication include hypertension (high blood pressure), high cholesterol, asthma, heart disease, and diabetes.
You will be able to fill your maintenance medication at your local pharmacy once with up to two refills. After that, you will be responsible for the full cost of the medication if you don’t use the mail order or Smart90 program through Walgreens.
If you use certain medications in the certain drug classifications, you will be identified for the step therapy program.
- Proton pump inhibitors (PPIs) for gastrointestinal treatment
- Statins for treatment of high cholesterol and other conditions
- ACE inhibitors/ARBs prescribed for hypertension and congestive heart failure
- Celebrex, sleep aids, nasal steroids, NSAIDS, tetracyclines, topical acne, corticosteroids, and immunomodulators
- Hepatitis C
- Multiple sclerosis
- Growth hormones
- Inflammatory conditions
- Attention Deficit Hyperactivity Disorder
When you are first prescribed a medication on the Step Therapy list, your pharmacist will advise you that you need to try a different drug prior to filling the one prescribed to you. If the alternative drug isn’t as effective as needed, you may use the medication originally prescribed to you.
Above are the most common drug classes that require step therapy, but there are other medications that may require review. Contact Express Scripts to determine whether your medication will be subject to step therapy.