Express Scripts Medicare PDP plan
This plan is an Employer Group Waiver Plan Plus Wrap, (aka “EGWP+Wrap”). It is a prescription drug benefit for Medicare retirees and retiree dependents who are eligible for Medicare. It is better than a standard Medicare Part D plan because of the additional coverage being provided by the State of Vermont that “wraps” around the standard plan. The “wrap” portion of the benefit allows the State of Vermont to supplement the plan so that the same drugs are available to members as in the active employee’s prescription drug plan. Officially, the name of this plan is Express Scripts Medicare® (PDP) for the State of Vermont, which how the plan will be referred to in further communications.
Impact of coverage
- The majority (but not all) of the drugs available under the active employee prescription drug plan will be available under the Express Scripts Medicare (PDP) Plan.
- You will still have the choice to fill your prescriptions at your local pharmacy or through mail order.
- The plan will still have an annual $25 deductible and coinsurance percentages of 10% for generics, 20% for preferred and 40% for non-preferred drugs will remain the same.
- Formulary changes that occur each year in the current plan will also occur in the Express Scripts Medicare (PDP) Plan. That means some prescription drugs may change from 20% to 40% and vice versa. These changes are minimal each year and you will be notified in advance of any and all changes as you are now. You can view the formulary for the Express Scripts Medicare (PDP) Plan by clicking Forms and Documents below. Formulary changes occur each year in both plans and may not always be changes to the same drugs.
- The majority of the pharmacies that you use now to fill your prescriptions will be in the new plan as well.
- You will be receiving a new prescription drug ID card for the Express Scripts Medicare (PDP) Plan. Each retiree or dependent who is eligible for Medicare will receive their own ID card. If you have family members who are not on Medicare, they will continue to use the current Express Scripts ID card that you have now.
- Low income Medicare eligible retirees and Medicare eligible retiree dependents may be eligible for assistance in paying for their prescription drug costs. For more information regarding this assistance, please refer to the “Eligibility and Enrollment” section of the CMS Medicare website.
- If your annual adjusted gross income is more than $85,000 as an individual or more than $170,000 as a couple filing a joint tax return, the Social Security Administration (SSA) will collect a small premium For more information regarding the impact of this regulation, please refer to the Part D-IRMAA section of the Medicare website .
- VA pharmacies are not included in the Medicare Part D network due to VA’s internal policy to not submit claims or invoices to other federally-funded health plans; however, members can choose to use their VA benefit instead of their Express Scripts Medicare benefit to cover medications with the VA network.
If you have questions, please contact the Retirement office (800) 642-3191 (within Vermont) or (802) 828-2305. You can also contact Express Scripts Medicare Customer Service at (844) 462-0431 starting 10/01/14. Finally, you can contact the Department of Human Resources at (802) 828-6700, option 1 and then option 3.