PRESCRIPTION DRUG PLAN
EXPRESS SCRIPTS
Benefits are provided through Express Scripts, a point-of-service provider. Please call 800-206-4005 for questions regarding benefits or network participating pharmacies or visit online at www.express-scripts.com.
If a new Insured Person incurs Rx claims within the first 6 weeks of enrollment, the Covered Person must pay for the Rx and submit a claim to Express Scripts after the 6th week at:
Express Scripts, Inc.
P.O. Box 66583
St. Louis, Missouri 63166-6773
Attn: STD Accts
Group Rx #GWTA
After 6 weeks, the Covered Person may go to any network pharmacy. The co-payment is $15 for generic drugs, $40 for brand name drugs, or $60 for non-formulary drugs, for eligible prescription drugs up to a 30 day supply per prescription or refill and up to a $1,500 maximum per year.
When a generic drug is available and you choose to purchase a brand name drug, even when the doctor writes “dispense as written” or “may not substitute,” you must pay the cost difference between the brand name
prescription and the generic prescription, in addition to your co-insurance.
After you have exhausted the $1,500 annual maximum, prescriptions can be purchased at a network pharmacy at a discounted rate, but you will be responsible for payment on these prescriptions.
If you do not use a participating pharmacy, you are responsible for the full cost of the prescription. For information about participating pharmacies or to obtain other information, please call Express Scripts at 800-206-4005.
*Once you have received an insurance/prescription card this means you are in the system and can just present your card at the pharmacy and no longer have to submit a claim form to Express Scripts.