Prescription drug benefits are included with each medical plan. These benefits play a critical role in your coverage, especially when you or your family members regularly rely on prescription drugs to stay healthy.
The prescription drug benefit you receive through Express Scripts offers convenience, cost savings, and flexibility—including the option to fill your prescriptions at a local in-network pharmacy of your choice, or receive up to a 90-day supply, delivered right to your door. To help you make well-informed decisions about your prescription drug needs, Express Scripts offers online tools to help you locate nearby pharmacies, compare costs, and more.
Key Highlights
- With the HSA Plan, once you meet your annual deductible, you and the plan will share in the cost of your prescriptions by paying a predetermined percentage.
- With the Surest Copay Plan, you do not need to meet a deductible before the plan will share the cost of your prescription drugs. You will owe a copayment depending on the prescription, however, you must use a participating Express Scripts pharmacy or the Express Scripts mail order service.
Pharmacy Plan Summary
| Prescriptions | HSA Plan | Surest Copay Plan | ||
|---|---|---|---|---|
| In-Network | Out-of-Network | In-Network | Out-of-Network | |
| Prescription Deductible (Individual/All Other Tiers) | Included in Medical | None | No coverage | |
| Prescription OOP Maximum (Individual/All Other Tiers) | Included in Medical | Included in Medical | No coverage | |
| Retail (30-day supply) | ||||
| Generic | Employee pays 20% after deductible | $10 copay | No coverage | |
| Formulary | Employee pays 30% after deductible | $60 copay | No coverage | |
| Non-Formulary | Employee pays 40% after deductible | $90 copay | No coverage | |
| Home Delivery (90-day supply) | ||||
| Generic | Employee pays 20% after deductible | No coverage | $25 copay | No coverage |
| Formulary | Employee pays 30% after deductible | No coverage | $150 copay | No coverage |
| Non-Formulary | Employee pays 40% after deductible | No coverage | $225 copay | No coverage |
For more information on the Express Scripts pharmacy benefit if you are not currently enrolled, including searching for in-network pharmacies, prescription drug coverage, visit the Express Scripts website. If you are already an Express Scripts member, visit the Express Scripts log-in portal.
