The County’s prescription medication coverage plan is administered by Express Scripts and their specialty pharmacy Accredo. Prescription coverage is included in the health insurance deduction from your paycheck.
Pharmacy (Applies to Both Health Plans)
- 30-day supplies of medications may be filled at any participating pharmacy.
- 90-day supplies of long-term maintenance medications must be filled at Walgreens or by Express Scripts home delivery.
- Specialty medications for complex conditions such as cancer must be filled by Accredo, the Express Scripts specialty pharmacy, which provides home delivery.
30-Day Supply of Medication
Point of Service (POS) Health Plan
- If you are enrolled in the POS Plan, generic drugs have a copay and brand drugs are subject to coinsurance within a specified range:
Point of Service (POS) Health Plan: Up to 30-Day Supply
|Preferred Specialty Brand
|Non-Preferred Specialty Brand
- Example: Bob has a 30-day supply of a preferred medication. Regardless of the contracted rate, he will pay at least $30 but not more than $60.
Consumer Driven Health Plan (CDHP) with Health Savings Account
- If you are enrolled in the CDHP, there are no copays. Your pharmacy costs are applied to your deductible. Once the deductible is met, you pay 20% coinsurance, as shown below:
Consumer Driven Health Plan (CDHP): Up to 30-Day Supply
|All drugs (generic, preferred, non-preferred, or specialty)
||The contracted rate up to the deductible, then 20% coinsurance
|*For the Consumer Driven Health Plan, medications on the Preventive Medicine List are free of charge for 30-day supplies at the pharmacy of your choice, except Walgreens and Express Scripts home delivery which require 90-day supplies per the Smart90 Program.
- Example #1: Jennifer has not met her deductible. She has a 30-day supply of a preferred medication with a contracted rate of $175. Because Jennifer has not met her deductible, she will pay the full contracted rate of $175.
- Example #2: John has met his deductible. He has a 30-day supply of a non-preferred specialty medication with a contracted rate of $300. John’s cost for a 30-day supply is $60 ($300 X 20% coinsurance = $60).
90-Day Supply of Medication (Smart90)
- The Exclusive Smart90/Walgreens Program applies to long-term medications for chronic conditions such as high blood pressure, diabetes and depression.
- If you have a prescription for a long-term maintenance medication used on an ongoing basis (three months or longer) you need to fill it for a 90-day supply at a Walgreens store or through Express Scripts home delivery, or you will pay the full retail cost of the medication.
- Smart90 does not apply to new prescriptions or medications unavailable in 90-day quantities.
- Smart90 does not prevent the use of cost-saving options such as discount cards, drug manufacturer assistance, or going to another store that offers medications at a lower cost. There are websites with price comparison lists including Express Scripts.
- For more information, see the Smart90 FAQs.
Point of Service (POS) and Consumer Driven Health Plans:
Up to 90-Day Supply
||Your Cost with Smart90 (Walgreens or Home Delivery)
||Your Cost with Another Pharmacy
||2 times the cost of 30-day supply
||Full retail cost
||Cost of 30-day supply
||Full retail cost
|*For the Consumer Driven Health Plan only, drugs on the Preventive Medicine List are free of charge for 90-day supplies if filled at Walgreens or Express Scripts home delivery.
- Example for the POS Plan: 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 at Walgreens or Express Scripts home delivery is $80 (20% of $200 = $40 X 2 = $80). If Sarah fills her 90-day prescription at another pharmacy such as CVS or Publix, she will pay the full retail cost of $600 unless she finds a lower cost alternative.
- Your prescription drug payments are applied to the combined out-of-pocket maximums under both health plans.
- Once you satisfy your out-of-pocket maximum, UnitedHealthcare and Express Scripts pay 100% of the cost for the rest of the plan year.
- Express Scripts provides ID cards to new members only. Cards are not reissued annually.
- Some employees still have a Medco ID card (Medco and Express Scripts merged). Either your Medco or Express Scripts card may be used at the pharmacy, but not your UnitedHealthcare ID card.
- To request or print an ID card, see the contact info below.
Visit Express-Scripts.com or call Express Scripts at (866) 544-9221.
NOTE: To create an online account, you will need to enter the member ID number found on your Medco or Express Scripts ID 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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