We want to ensure our members and their families to get the most out of the benefits we provide them by providing the most up-to-date library of resources.
To reduce the cost of your long-term or maintenance medications for both you and the health plan, medications for maintenance or long-term use must be filled by mail order or at a pharmacy participating in our Restricted Retail Pharmacy Network for a 90-day (3-month) supply.
The 31-90-day copay schedule is listed below. The full Prescription Benefit Schedule, which is the same for both the Premium and Basic plans, may be found in the Premium Schedule of Benefits and on the Basic Schedule of Benefits. If mail order or the Restricted Retail Pharmacy Network is not used for your maintenance medications, you will pay the full cost of the drug.
Important note:Walgreens and CVS are not in the Restricted Retail Pharmacy Network.
For a list of participating pharmacies on the Restricted Retail Pharmacy Network, log in or register at express-scripts.com/90day or call Express Scripts at 866.890.1419.
Prescription Benefit Schedule for 31-90-day supply through Restricted Retail or mail order
MIN/MAX Copay per script
Member Coinsurance
Generic Medication
$20 / $40
10%
Preferred Brand1 Drug Medication
$40 / $150
30%
Non-Preferred Brand1 Drug Medication
$60 / $250
40%
Diabetes & Insulin Supplies
$20 / $100
10%
1Member Pays the Difference – When you fill a brand prescription when the generic equivalent is available, you pay the difference in the brand cost versus the generic cost plus the generic copay. Generic drugs are the same active chemical elements as the brand name drugs. Check with your doctor or pharmacist about taking advantage of generic drugs with lower copays. If you are not able to take the generic due to documented clinical reasons, please submit an appeal to pay the brand copay even though a generic is available.
