Prescription Insurance

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Prescription benefits are part of the Medical Plan; therefore, employees and their family members who are covered by a Medical Insurance Program are eligible for this benefit. Prescription coverage is effective as of the date medical coverage is effective. Prescriptions are available through a participating Pharmacy or through Home Delivery service.

Provider

Express Scripts     |     Website: https://www.express-scripts.com/     |     Ph:  877-852-4060
Prescription Summary of Benefits     |    Required mail order maintenance medication list     |     2017 National Preferred Formulary     

2017 Preferred Drug List Exclusions     |     Express Scripts Prescription Plan Presentation

This table compares retail and mail order costs for prescriptions through Express Scripts.
Retail (30-day supply) Mail Order (90-day supply)
If you obtain a brand-name drug when a generic equivalent is available, you are responsible for the generic co-payment plus the cost difference between the brand-name drug and the generic drug.
Deductible $50 Individual / $100 Family only on Non-Generics (applies to Medical Out of Pocket Maximum)
Generic $6 $17
Brand (Preferred) 30% ($35 min/$95 max) $120
Brand (Non-Preferred) 40% ($60 min/$130 max) $155
Specialty Medications- Must move to mail order after 2 fills at retail $60 for generic

$85 preferred brand

$125 non-preferred brand

$60 for generic

$85 preferred brand

$125 non-preferred brand

Reminder: the pharmacy benefit has a $50 deductible for single coverage and a $100 family deductible for all non-generic prescriptions. The deductible must be met in its entirety before the pharmacy plan will revert to the co-pay/co-insurance payment structure. All deductible, copay and co-insurance amounts will be counted toward the medical out of pocket maximum.

Prescription Plan Changes for 2017

  • Participants who fill maintenance medications at the local pharmacy (30 day supply) will be charged the 90 day home delivery rate for refills as of the 3rd refill at the local pharmacy. To avoid being charged the higher rate, participants should change their maintenance medication to home delivery before the 3rd refill.

 

drug_testingMedicare Part D Coverage (Prescription Drug)

Medicare requires all employers that offer prescription plan coverage to send all participants an annual notice to inform them if the prescription plan is creditable. Creditable means that the employer sponsored plan is at least as good as the coverage offered through Medicare Part D.

Notice of Creditable Coverage from the state of New Mexico – This document may be printed and provided to the U.S. Social Security Administration at the time you request to enroll in a Medicare Part D plan. Questions regarding the notice should be directed to Erisa Administrative Services, Inc. on behalf of the State of New Mexico at 855-618-1800.