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Prescription Drug Benefits

 

Prescription Drug Coverage for the Aetna and Blue Cross Blue Shield PPO Participants

The Plan’s Prescription Drug Plan uses Express Scripts for pharmacy benefits — giving you access to the very the same network you used under the UPS Company Health Plan. The Express Scripts’ network includes most major pharmacy chains and thousands of independent pharmacies in all parts of the country. What you’ll pay depends on how you fill your prescription.

 

When you fill a prescription at a retail pharmacy, you’ll pay a $5 copay. If your doctor prescribes a maintenance medication (i.e., those that are taken on a regular basis and usually prescribed in 90-day supplies), you can access Express Scripts’ mail-order service and pay no copay ($0) to fill a generic prescription.

 

Aetna and Blue Cross Blue Shield PPO Plan Prescription Drug Benefits

 

Your Cost In-Network

Retail Pharmacy

$5 copay for generic (or brand if no generic equivalent). If you fill a maintenance medication at a retail pharmacy more than two times, your copay will increase to 50% of the cost of the medication.

Mail-Order Program (for maintenance medications)

$0 copay for generic or brand (if no generic equivalent)

 

Using the Mail-Order Program

There are three ways to order medications you take on a regular basis from the Express Scripts:

  1. Online: Activate your account at www.StartHomeDelivery.com any time after June 1, 2014.
  2. By Mail: Mail in the order form included in your member packet, along with your 90‐day prescription.
  3. By Phone: Call the number on the back of your Express Scripts ID card, and they’ll do the work for you. The first time you fill a prescription through the Express Scripts mail order pharmacy, you can expect to receive your order within two weeks from the time your prescription was received (so it’s a good idea to please have a 30-day supply of your medication on hand when you enroll).

 

Once you’ve completed the appropriate form (visit www.express-scripts.com) and established a routine with your prescribing physician, your maintenance medications will automatically ship to you. Refills generally take three to five days to ship.

 

Mandatory Generics

The cost of prescription drugs is one of the most significant factors in the rising costs of health care in America. The Plan addresses this challenge while still providing a high quality prescription drug program. Our Plan features a mandatory generics policy. This means that if a generic drug is available, but you choose the brand name instead you will be responsible for the cost difference between the price of the brand name drug and the generic drug, plus the copay. *

 

Research shows that for the majority of people, generics work just as well as brand-name drugs.

  • Generic drugs are required to have the same active ingredient, strength, dosage form, and route of administration as their brand-name counterparts.
  • All generic manufacturing, packaging, and testing sites must pass the same quality standards as those of brand-name drugs, and the generics must meet the same exacting specifications as any brand-name product.
  • On average, the cost of a generic is 80 to 85 percent lower than the brand-name product.

 

   Cheaper does not mean lower quality:

  • Generic manufacturers are able to sell their products for lower prices because they are not required to repeat the costly clinical trials of new drugs.
  • Generally, generic manufacturers do not pay for advertising, marketing, and promotion.
  • Multiple generic companies are often approved to market a single product; this creates competition in the market place, often resulting in lower prices.  

  Exception - If the brand name drug is medically required, it will be covered if approved by Express Scripts. Please call 800-753-2851 for approval.

Kaiser Permanente HMO Plan Prescription Drug Benefits

 

Prescription Drug Benefits (Kaiser Plan Pharmacies)

Retail Pharmacy

$5 copay for generic (or brand if no generic equivalent) up to a 100-day supply when deemed medically necessary, prescribed by a Plan physician, and obtained at Kaiser Permanente Plan pharmacies

$10 copay for generic (or $20 copay for brand if no generic equivalent) up to a 30-day supply when deemed medically necessary, prescribed by a Plan physician, and obtained at Kaiser Permanente Plan pharmacies

Mail-Order Program
( for maintenance medications)

$5 copay for generic (or brand if no generic equivalent) up to a 100-day supply when deemed medically necessary, prescribed by a Plan physician, and obtained through Kaiser Permanente Plan mail order

$10 copay for generic (or $40 copay for brand if no generic equivalent) up to a 90-day supply when deemed medically necessary, prescribed by a Plan physician, and obtained through Kaiser Permanente Plan mail order

 FAQs

Why did I receive a personalized letter from express scripts saying my drug would no longer be covered?

A national panel of physicians and pharmacists continually reviews and compares prescription drugs to ensure your drug list includes proven medications to treat every condition. Some drugs may no longer be included when other safe and effective alternatives are available. If you received this letter, talk with your doctor about your 2014 drug list change. To avoid paying the full retail price of your current medication after June 1st, get a new prescription for a safe, effective, covered alternative. List of alternatives, 2016 List

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