Humira Brand Coverage Update
Dec 19, 2024
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.
Choose your way to save with a 3-month supply:
Express Scripts mail order | or | Restricted Retail Pharmacies |
Delivered to your door with standard shipping | At convenient locations near you (find locations at express-scripts.com/90day) | |
Transfer prescriptions easily online, by phone or via the Express Scripts mobile app | Transfer your prescriptions easily in-store, by phone or online | |
Auto-refills and refill reminders available | Ask about auto refills and refill reminders | |
Talk with an Express Scripts pharmacist by phone 24/7 | Coverage is the same as Express Scripts home delivery |
To receive a 3-month supply and avoid paying more, log in or register on express-scripts.com/90day.
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.
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