Prescription Coverage

The County’s prescription medication coverage plan is administered by Express Scripts.com . You pay no additional premium for prescription benefits. They are included in your health insurance deduction from your paycheck.

The cost for your prescription medications depends on the health plan you have chosen and the type of medication.

Choice Plus POS: 

Generic, Preferred & Non-Preferred Medication

If you are enrolled in the Choice Plus POS health plan, costs for generic prescriptions have a preset co-pay. Preferred and non-preferred brands are subject to a minimum co-insurance payment:

• Generic: $15 co-pay
• Preferred Brand: Participants can expect to pay 20% co-insurance for the cost of the drug. The minimum out-of-pocket is $30 and will not exceed $60. 
• Non-Preferred Brand: Participants can expect to pay 40% co-insurance for the cost of the drug. The minimum out-of-pocket is $45 and will not exceed $90.

(Retail pharmacies or mail order)

• Two (2) times the cost of a 30-day supply
  • 90-day supply example: Sarah has a prescription for a 90-day supply of a preferred maintenance medication. The retail cost is $200 for a 30-day supply. Sarah's cost for a 90-day supply is $80 (20% of $200 = $40 X 2 months).

It is recommended that long-term medications be filled at your local retail pharmacy or by mail order for a 90-day supply. A 90-day supply of long-term medications costs less than three 30-day supplies at a retail pharmacy. Long-term medications that are not ordered in a 90-day supply will have an additional 50% fee starting on the third fill.

• Third fill fee example: Tim has a prescription for a 30-day supply of a preferred maintenance medication that costs $30. On the third fill, Tim will pay $45 at the pharmacy for 30 days (cost of drug + 50% of drug cost). If Tim ordered a 90-day supply, he would pay less—$60 for 90 days.

Specialty Medication

Up to 30-day supply retail:

• Preferred Specialty Drugs: Participants can expect to pay 20% co-insurance for the cost of the drug. The minimum out-of-pocket is $60 and will not exceed $120.
• Non-Preferred Specialty Drugs: Participants can expect to pay 40% co-insurance for the cost of the drug. The minimum out-of-pocket is $90 and will not exceed $180.

Up to 90-day supply:
(Retail pharmacies or mail order)

• One (1) time the cost of a 30-day supply
  • 90-day supply example: Sam has a prescription for a 90-day supply of a non-preferred specialty medication. The retail cost is $400 for a 30-day supply. Sam’s cost for a 90-day supply is $160 (40% of $400 = $160 X 1 month).

Choice Plus HSA: 

• If you are enrolled in the Choice Plus HSA health plan, you have no co-pays for your prescription medications.
• Medications that are included on the preventive listing of drugs are free of charge; other medications are subject to your deductible and once the deductible has been met your cost will be 20% coinsurance.
  • Prescription Example #1: Jennifer has not met her deductible. She has a 30-day supply of a preferred medication with a retail cost of $175. Because Jennifer has not met her deductible, she will pay the full retail cost of $175. 
  • Prescription Example #2: John has met his deductible.  He has a 30-day supply of a specialty non-preferred medication with a retail cost of $300.  John’s cost for a 30-day supply is $60 ($300 – 20% coinsurance = $60). 
• Prescription drug copays are applied to the combined out-of-pocket maximum (see Health Plans Comparison Chart for maximum out-of-pocket amounts). Once you have satisfied your out-of-pocket maximum, United Healthcare and Express Scripts pay 100% of the cost for the rest of the plan year.

ID Card:

• Express Scripts provides ID cards to new members only. Cards are not reissued annually.
• Many employees still have a Medco ID card (Medco and Express Scripts have merged). Either a Medco or Express Scripts card may be used at the pharmacy.
• To request or print an ID card, see the contact info below.

Contact Info: 

Call Express Scripts at (866) 544-9221 or visit Express-Scripts.com NOTE: To create an online account, you will need to enter the member ID number found on your Medco or Express Scripts ID card (do not use the member ID number on your United Healthcare card).

Use the Express Scripts website to:

• Request or print an ID card or forms
• Locate a participating retail pharmacy
• View the benefits of your prescription coverage
• Price the cost of a medication
• View alternative medications and their cost
• View your prescription history

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