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

30-day copayment for retail table
  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

90-day copayment for mail order table
  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

30-day copayment for specialty prescription table
  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.

Accredo Pharmacy

Accredo Pharmacy provides specialty and specialty injectable prescription benefits.

Specialty and injectable drugs:

  • 30-day supply limit
  • Refills through specialty pharmacy only (mail order)
  • Accredo Specialty Pharmacy telephone, 877-222-7336

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:

  1. medically necessary and essential to your health and safety and/or
  2. all covered formulary drugs comparable to the excluded drug have been tried.

Refer to the Express Scripts National Preferred Formulary Exclusions. 

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)

 

 

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