Prescription Drugs
When you enroll in the Consumer Choice Plan for medical coverage, you automatically receive prescription drug coverage through Express Scripts.
How it works
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 your medical plan SPD: Blue Cross Blue Shield Medical SPD (employees in Illinois) or UnitedHealthcare Medical SPD (employees outside of Illinois).
Beginning in 2021, prescription drugs for infertility have a separate lifetime limit of $40,000.
| Features | Non-Participating Pharmacy | |
|---|---|---|
| Annual Deductible | Medical 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 copay | Copays 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 copay | Not 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.
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