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Prescription Drug Coverage
Learn about copays, covered drugs, generics and specialty prescriptions.
Copayments Information
Review information on 30 and 90 day copayments for prescriptions.
30-Day Copayment for Retail
| High Option | Low Option | HDHP Option | |
|---|---|---|---|
| Generic Prescription | $10 | $10 | $10 after deductible met |
| Preferred brand-name prescription | $25 | $30 | $35 after deductible met |
| Non-preferred brand-name prescription | $45 | $60 | $60 after deductible met |
| Compound drugs | 20% coinsurance up to max of $90 per Rx | 20% coinsurance up to max of $90 per Rx | 20% coinsurance up to max of $90 per Rx after deductible met |
90-Day Copayment for Mail Order
| High Option | Low Option | HDHP Option | |
|---|---|---|---|
| Generic Prescription | $20 | $20 | $25 after deductible met |
| Preferred brand-name Prescription | $50 | $60 | $87.50 after deductible met |
| Nonpreferred brand-name prescription | $90 | $120 | $150 after deductible met |
30-Day Copayment for Speciality Prescriptions
| High Option | Low Option | HDHP Option | |
|---|---|---|---|
| Specialty Prescriptions | $60 | $90 | $90 after deductible met |
Mandatory Generics
The City's prescription drug plan includes mandatory Generics.
This means, if you want the brand-name drug, and a generic equivalent is available, you may still receive the brand-name drug; however, your out-of-pocket cost will be greater. In this instance, you will pay the brand-name copayment plus the difference of the cost between the generic and the brand-name drug.
Covered Drugs Information
Certain brand-name medications as well as compound drugs that contain certain ingredients may not be covered under the Plan. If you fill a prescription for a non-covered brand-name or compound medication you will be responsible for the full cost of the medication and that cost will not be applied to your out-of-pocket maximum. Talk with your physician about prescribing an alternative covered medication.
Drugs that are excluded under the Plan may be covered if approved in advance through a formulary exception process initiated by your physician and managed by Express Scripts, on the basis that the drug is:
- medically necessary and essential to your health and safety and/or
- all covered formulary drugs comparable to the excluded drug have been tried.
Refer to the Express Scripts National Preferred Formulary Exclusions.
Accredo Pharmacy
Accredo Pharmacy provides specialty and specialty injectable prescription benefits.
- 30-day supply limit
- Refills through specialty pharmacy only (mail order)
- Accredo Specialty Pharmacy telephone, 877-222-7336
Contacts for Questions about Coverage
If you are an enrolled employee of the City and have questions regarding your prescription drug coverage, you can contact Express Scripts at 1-866-595-7317.
Express Scripts 1-800-451-6245 (Formulary and Prescription Drug Benefit Information)
Accredo 1-877-222-7336 (Specialty Drug Benefit Information)
