What you pay
|For Choice HSA, Value HSA or Choice HRA medical plan option only||For Value HRA medical plan option only|
|Retail pharmacy |
|Express Scripts mail order service or Smart90 Walgreens|
|Retail pharmacy |
|Express Scripts mail order service or Smart90 Walgreens
|Medical plan deductible applies||Yes||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||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%|
|Contraceptives — generic||Covered in full||Covered in full|
|Preventive — generic & preferred||Covered in full||Covered in full|
To check how your prescriptions will be covered under the HSA and HRA Plans, 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.
- 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.
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.
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.
The plan offers convenient access to vaccines from local retail pharmacies.