Prescription Drug Plan
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Overview
Express Scripts will administer for all participants one prescription drug plan with a three-tiered copay structure tied to a formulary drug list (PDF) and a generics preferred policy. You are automatically enrolled for the prescription drug benefit when you enroll for UnitedHealthcare PPO300, PPO600 or EPO medical benefits. Express Scripts pharmacy network includes more than 58,500 participating pharmacies including Walgreens, CVS, Rite Aid, Wal-Mart and Eckerds. Present your Express Scripts ID card when you or a covered family member fills a prescription. Contact Express Scripts at 866-291-2607 to locate a participating network pharmacy.
The amount you pay for each prescription depends on whether the drug is a brand or generic medication, whether it appears on the formulary list of preferred medication, and whether it is purchased at a network pharmacy or through Express Scripts home delivery. The three-tiered copay benefit arrangement makes preferred drugs available to you at more attractive copays. You still have access to medications not on the formulary, but at the higher non-formulary copay.
A formulary is a list of preferred medications that includes drugs that are safe, clinically effective and economical. The formulary list (PDF) was developed by an expert committee of independent pharmacists and physicians. These medications are clinically effective and cost-effective. You will save money by selecting preferred drugs from the formulary listing. Choosing medications not listed on the formulary will require you to share more of the cost in the form of a higher copay. In order to save money, you and your doctor should be aware of this formulary drug list and select from the medications listed.
The prescription drug plan has a generics preferred policy to encourage participants to request generic drugs when available and appropriate. Choosing generic drugs and paying the lower copay is the most cost-effective way to help control the rising costs of prescription drugs. Here is how it works:
For all prescriptions filled by home delivery and network pharmacies, Express Scripts' policy is to fill a prescription with the generic equivalent drug unless the prescription specifically states, "do not substitute." Prescriptions where the physician has specified DAW (dispense as written) will be filled with the brand drug. If DAW is not noted, Express Scripts will automatically dispense a generic equivalent drug. If you choose a brand drug when a generic equivalent is available or your physician has specified DAW, you will pay the brand copay plus the cost difference between the brand drug and the generic drug.
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Take note of the special savings by using the Express Scripts home delivery. Order or refill your 90-day supply of maintenance drugs — pay just one copay and your prescriptions are shipped free of charge to your home address. Filling the same prescription at a network pharmacy would require three 30-day supplies and three copays. Enjoy additional savings by asking your pharmacist if a generic equivalent drug is available for your prescription. If you anticipate a lot of prescription drug expenses, you should consider opening a Health Care Spending Account. This allows you to save money to pay for predictable medical expenses.
Step Therapy Program
The Express Scripts pharmacy plan includes a Step Therapy Program for drugs used to treat medical conditions such as arthritis, high blood pressure, gastrointestinal disorders and depression. When many different drugs are available for treating a condition, a Step Therapy Program is helpful in finding the most appropriate, cost-effective drug treatment. To learn more about step therapy, read the online brochure (PDF) or contact Express Scripts at 866-291-2607.
Specialty Medications
CuraScript, Express Scripts' specialty pharmacy, serves your specialty prescription needs. Express Scripts defines specialty medications as having one or more of several key characteristics including:
- Cost in excess of $500 for a 30-day supply
- Requirement for frequent dosing adjustments and intensive clinical monitoring to decrease the potential for drug toxicity and increase the probability of beneficial treatment outcomes
- Need for intensive patient training and compliance assistance to facilitate therapeutic goals
- Limited or exclusive product availability and distribution
- Specialized product handling and/or administrative requirements
Specialty medications covered under your prescription drug plan require a 20 percent copay with a maximum out-of-pocket of $150 per prescription. Your annual maximum out-of-pocket for specialty medications will be $2,000 per member and $4,000 per family. The maximum days supply for your specialty medications is 30 days. To reach CuraScript Specialty Pharmacy, call 866-848-9870.
Need to find out the price of a prescription?
Members registered with Express Scripts can use the Price Check feature to find out costs of specific drugs. You can register online with Express Scripts.
Once you have registered, go to
How much will my prescription cost?
You can receive a price instantly, and find out how you can save money by choosing home delivery and generic alternatives!
Express Preview for 2008 (https://member.express-scripts.com/preview/enterprise2008)
Take a look at the 2008 prescription drug plan and learn how much specific drugs will cost. This allows you to estimate maintenance prescription drug costs for 2008 and can help you determine how much to set aside in your Health Care Spending Account. If you are not yet registered on the Express Scripts web site, Express Preview will ask you to complete a brief registration process.
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