Prescription Drugs

Coverage

The plan has an annual deductible of $25 per person, per year (maximum $75/family). After the deductible is met, the plan pays:

  • 90% of the cost for Generic Drugs;
  • 80% of the cost for Preferred Brand Drugs; and
  • 60% of the cost for Non-Preferred Brand Drugs.

A copy of the most current State of Vermont Preferred Drug List is available by clicking the link below.
State of Vermont 2013 Preferred Drug List (pdf)
The maximum amount an individual may pay out of their pocket is:

  • $775 including the $25 deductible during 2013.

After an individual has paid the maximum amount listed above, the plan will cover all future prescriptions at 100% for the rest of the plan year. Please note that starting in 2009, any Non-Preferred Brand Drug purchased (excluding Specialty Drugs), the 40% that an individual pays will not count towards the maximum.

Other Information

You can purchase up to a 90 day supply of most medications. However, the first time a prescription is filled, you will only be given a 30 day supply. This is to be sure you can tolerate the medication with no adverse effects. There are three ways to fill your prescriptions:

Retail Pharmacy – Just present your ID card and prescription at most chain and/or independent pharmacies across the country. A list of participating pharmacies can be found on the Express Scripts web site.

Mail Order Pharmacy – Have your doctor provide you with a prescription for at least a 90 day supply plus appropriate refills for up to one year. Insert the prescription and completed form in the mailer and drop in the mailbox. Your medication will be delivered to your home free of shipping costs within two weeks. Mail service provides the convenience of home delivery with the opportunity to save on your copays due to lower drug prices available at the mail order pharmacy. Mail order forms are available by clicking the link in the Forms and Documents section or by calling the Employee Benefits Unit.

Online Ordering with Mail Delivery – to order your prescriptions online, go to the Express Scripts web site link below and follow the instructions. If you have an active prescription on file at one of the participating pharmacies, you will not need to get a new prescription.

Cost

There is no additional cost as your prescription coverage is part of your elected medical health insurance plan.

Eligibility

Employees are enrolled automatically when they enroll in the SelectCare, TotalChoice, or HealthGuard Plans.

Administrator

Express Scripts, Inc.
PO Box 8545
Bensalem, PA 19020-8545
(800) 550-8090 (available 24 hours)

www.express-scripts.com