Prescription Drug

When you enroll in a PPO or Out-of-Area Comprehensive Medical Plan option, your prescription drug benefits are provided through the Medco Health network. This means you’ll receive the highest level of benefits if you use Medco’s home-delivery pharmacy service or a retail pharmacy that participates in the Medco Health network.

How It Works

Your prescription drug benefits are provided by Medco Health. Express Scripts and Medco Health Solutions, Inc. have come together as one company to manage your prescription benefit. Medco is now a part of the Express Scripts family of pharmacies.

How Prescriptions Are Filled

If you fill your prescriptions through:

  • A participating retail pharmacy, you will receive in-network benefits.
  • The home-delivery pharmacy service, you will receive cost savings on your maintenance medications.
  • An out-of-network retail pharmacy, you will be responsible for the full cost of the drug at the time of purchase (and a lower level of benefits) and you will need to submit a claim to Medco Health for reimbursement.

For a list of participating network retail pharmacies, contact Medco Health at 1-800-711-3460 or visit www.medcohealth.com.

Coverage

You can choose from among three types of medication when it comes to your prescription drug needs:

  • Generic drugs
  • Preferred brand-name drugs
  • Non-preferred brand-name drugs

You’ll pay the least amount for generic and the preferred brand-name drugs included on the Medco Health Formulary—so it’s important to take a copy of the formulary with you to the doctor. Talk to him or her to see if a less-costly equivalent drug is available for your needs. To obtain a copy of the formulary, visit the Medco Web site, or contact Medco Health at 1-800-711-3460.

Pay-the-Difference Feature

If you choose a brand-name drug that has a generic equivalent available, you will pay the applicable brand-name coinsurance amount, PLUS, the dollar difference between the cost of the generic and the brand-name drug. This rule applies even if your prescribing doctor indicates your prescription should be “Dispense as Written.” To avoid paying more for a drug that has a generic equivalent, it is important that you always ask if a generic is available and appropriate for your needs when getting a prescription from your doctor.

Note: The amount of the difference between the brand-name drug and generic alternative does not count toward satisfying the out-of-pocket maximum for drugs filled through the home-delivery pharmacy service.

Retail Refill Allowance (RRA) for Maintenance Medications

You’re permitted three fills (the original plus two refills) at a retail pharmacy at the retail coinsurance amount for long-term or maintenance medications. For additional refills of the same medication at an in-network retail pharmacy, you’ll have to pay 60% of the cost of that medication.

To avoid paying the increased price, you’ll be required to get additional refills of that same prescription through the home-delivery pharmacy service. How does this work? After the second time you fill a long-term or maintenance drug through the retail pharmacy, you’ll receive a letter from Medco Health reminding you of this provision and explaining how to switch that prescription to the home-delivery pharmacy service.

Example: How Home Delivery Can Save You Money:*

Let’s assume you need a six-month (180-day) supply of Nexium® Caps (20 mg).

 

In-Network Retail Pharmacy Home Delivery Pharmacy Service
Month 1 $40.00 for first 30-day prescription $100.00 for a 90-day supply
Month 2 $40.00 for first refill N/A
Months 3 $40.00 for second refill N/A
Months 4 – 6 $118.00 (60% of $196.67 for 3 months) for additional refills $100.00 for a 90-day supply
Total $474.00 for a 180-day supply $200.00 for a 180-day supply

*All drug prices in this example are current as of October 11, 2012.

 

Note: With the home-delivery pharmacy service, you’ll pay for a 90-day supply even if your prescription is written for up to a 30-day supply. This means if you fill a prescription that is written for a 30-day supply through the home-delivery pharmacy service, you’ll pay the applicable home delivery pharmacy service 90-day supply coinsurance amount. In the case of a new prescription, however, Medco Health will allow a 30-day supply, at a 30-day coinsurance amount, on a first-time trial basis only.

Getting Started with Home Delivery

First, talk with your physician about your desire to save money by using the home delivery pharmacy service for your maintenance medication. Then, ask him/her to fill out the “Prescription Fax Form” which can be found on Medco Web site at www.medcohealth.com or by calling 1-888-EASYRX1 (number for physicians only). The form includes instructions on how to fill out and fax it. Please note that only your physician can fax the completed form. However, your physician may prefer to have you mail in your prescription. You can access the online form at www.medcohealth.com or you can call Medco at 1-800-711-3460 and ask to have a form mailed to you. Instructions on how to download and print the form are included on the Medco site. Just complete the form and mail it with your prescription to the address provided.

Once Medco receives your prescription, your order will be processed within three to five days. It may take up to two weeks until you receive your new order, so have your doctor write a 30-day prescription to have filled at your local pharmacy in addition to the 90-day prescription for home
delivery.
All prescriptions will be delivered to you with free standard shipping, unless you request express shipping. Keep in mind, for a new prescription it makes sense to use your local retail pharmacy until your doctor is comfortable that the new drug will work for you.

For more information about Prescription Drug coverage, review the Summary of Health Benefits.

For retirees, learn about your prescription drug benefits in the Retiree Annual Enrollment Guide.