Prescription Benefits
Here are a few things you should know about your prescription drug benefits:
  • Co-insurance applies to your out-of-pocket maximum
  • Our pharmacy benefit manager has a new name – Express Scripts, formerly Medco
  • Do you take long-term (maintenance) medications? Be sure to move your prescription to mail order to keep your costs down. You will pay 50% of the retail drug cost if you don’t move your prescription to mail order after your initial purchase plus two refills. You can order a 90-day supply which means fewer refills and you can set it up directly with Express Scripts, formerly Medco to ship automatically. Visit Express Scripts to determine if your medication is subject to this requirement.
  • Oral contraceptives are covered by mail only at 100% with no co-pay or co-insurance. If a brand contraceptive has a generic equivalent, you will be responsible for the cost difference between the generic and brand prices.
  • Using a brand name drug when a generic is available will typically cost you more – so have a discussion with your doctor about your prescriptions
  • If you are taking medication for diabetes and/or high blood pressure, you may be eligible for a discount through Healthmatters StayWell Rx medications. Here’s how:
    • Call 1-888-227-6598 to speak with a Health Advocate and to confirm your medication is part of the Healthmatters StayWell Rx program, then enroll. Make sure you do this before you fill your eligible prescription
    • Have a call with a Health Advocate nurse to learn about ways to better control your condition
    • Fill your eligible prescriptions through Express Scripts mail order after your call. Continue phone calls with your nurse every 90 days to keep your discount