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BMO U.S. Benefits

Prescription Drugs

When you enroll in the Consumer Choice Plan for medical coverage, you automatically receive prescription drug coverage through Express Scripts.
 

You pay the full cost for prescription drugs until you meet the medical plan deductible. Then you pay the applicable copay. The plan pays 100% once you meet the medical plan out-of-pocket maximum. Prescription drugs are not subject to a separate out-of-pocket maximum. Certain preventive drugs are covered 100%, the deductible does not apply.

Here’s a high-level overview of the prescription drug benefit. For details, review the Medical SPD.

Features Participating Pharmacy
Non-Participating Pharmacy
Annual DeductibleMedical plan deductible applies
Annual Out-of-Pocket Maximum
Eligible expenses apply toward the individual and family in-network medical out-of-pocket maximum
What you pay
Retail (up to 30-day supply)
Generic$10 copay
Copays same as a participating pharmacy, but retail pricing applies
Formulary (preferred brand)25% (min $20; max $50)
Nonformulary (non-preferred brand)35% (min $40; max $70)
Retail (31 to 90-day supply)
Generic$30 copayCopays same as a participating pharmacy, but retail pricing applies
Formulary (preferred brand)25% (min $60; max $150)
Nonformulary (non-preferred brand)35% (min $120; max $210)
Mail Order (up to 90-day supply)
Generic$20 copayNot covered
Formulary (preferred brand)25% (min $40; max $100)Not covered
Nonformulary (non-preferred brand)35% (min $80; max $140)Not covered

If you request a brand-name drug when a generic is available, you will pay the generic copay plus the difference in cost between the brand and the generic.

Express Scripts app

Skip the pharmacy trip and download the Express Scripts mobile app.

  • View your past prescription activity and payment details.
  • Switch to home delivery.
  • Manage prescriptions and check for drug interactions.
  • Refill and renew home delivery prescriptions.
  • Check order status.
  • Access your ID card at any time.

Express Scripts



 
 

Support from Express Scripts

Programs that offer financial support for prescription drugs:

  • Mail order payment: Pay for mail order prescriptions in three monthly installments with the Extended Payment Program.
  • Patient Assurance Program: Limits cost of 30-day preferred insulin prescription to no more than $25.

LEARN MORE

Need assistance?

For specific prescription drug costs,
contact Express Scripts Member Services.

1-877-795-2926
Monday through Friday, from 8 a.m. to 5 p.m. CT