Retiree Prescription Drug Plan
Express Scripts will continue to provide prescription coverage included with each of the medical plans. For 2018, there will be some plan enhancements to offer you more convenience and cost savings.
- Walgreens and CVS will be added to the preferred network of pharmacies with no surcharges, adding on to the existing network of retailers that includes Wal-Mart, K-Mart, Kroger, Target, Costco, Safeway, Albertsons, and Rite Aid.
A 90-day retail option will be available through Walgreens for maintenance medication.
- Your costs are capped
- Your medical plan’s out-of-pocket maximum includes prescription costs. If you reach the out-of-pocket maximum, Windstream pays 100% of your prescription costs for the rest of the year.
- Price your prescription
- Before you fill a prescription ask your doctor about your options. Generic prescriptions are usually less expensive than name-brand medications. You should also consult with your pharmacist about the cost, as many retailers offer generic discount programs that may save you more.
- All prescription costs filed with your insurance card will apply toward meeting your deductible.
- You can research the cost of prescriptions by logging in to your Express Scripts account at express-scripts.com.
Prescription Plan Rates
Filling a Prescription
When you fill a prescription, you pay the retail price until you reach your deductible. Both medical and pharmacy expenses count toward meeting your deductible. After meeting your deductible, you pay your coinsurance rate until you reach the out-of-pocket maximum at which time Windstream pays 100% of the prescription cost.
You may fill up to a 30-day supply at a retail pharmacy. Maintenance medications must be filled via home delivery after two orders have been filled at a retail pharmacy other than Walgreens. An additional $10 charge is added if the retail prescription is filled at a non-network pharmacy. The pharmacy network includes retailers such as Wal-Mart, K-Mart, Kroger, Target, Costco, Safeway, Albertsons, and Rite-Aid.
A Note About Generics
Before you fill a prescription ask your doctor about your options. Generic prescriptions are usually less expensive than a name-brand medication. You should also consult with your pharmacist about the cost, as many retailers offer generic discount programs that may save you more.
All prescription costs filed with your insurance card will apply toward meeting your deductible.
You can research the cost of prescriptions by logging into your Express Scripts account at express-scripts.com.
Prescription Terms you need to know
Generic – A generic drug is identical–or bioequivalent–to a brand name drug in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use. Although generic drugs are chemically identical to their branded counterparts, they are typically sold at substantial discounts from the branded price.
Formulary – A drug formulary is a list of preferred prescription drugs, that offer the greatest overall value and is preferred by your insurance plan. You will pay more if you and your doctor choose a medication that is not covered on your health plan’s formulary. You can review the formulary list at WindstreamHealth.com.
Brand Formulary – A brand name formulary prescription is included in the preferred formulary, but is more expensive than generic alternatives.
Specialty Medication – Medications which require special dosing or administration, are typically prescribed by a specialist and are more expensive than most medications. They may include biosimilar specialty drugs.
Generic drugs, when available, are the most cost-effective purchasing decision for Windstream as a whole and for you individually, and many therapy classes have a range of cost-effective generic options. When a brand name drug becomes available as a generic, by law, the generic drugs must meet the same standards for safety, purity, strength and quality. These generics are considered chemically equivalent to the brand name drug.
Certain prescription drugs require prior authorization to confirm appropriateness of treatment. The prescribing physician should call Express Scripts before submission to the pharmacy to avoid delays and to expedite the authorization process. The list of medications requiring prior authorization is published by Express Scripts and available at express-scripts.com.
Step Therapy is a drug protocol management tool used to ensure appropriate drug therapies for certain conditions. The Step Therapy program recommends using a less expensive treatment that is known to be safe and effective for most people – referred to as a first-line drug – prior to using a more expensive drug for the same condition. The Express Scripts system will alert your pharmacist that your medication requires prior authorization if you are trying to fill a prescription for a drug that is not identified as a first- line drug within a class that requires step therapy. If this occurs, you will need to contact your physician to either switch to a first-line drug or have your physician call Express Scripts for information on how to obtain a prior authorization for a second-line drug.
If you are using a specialty medication, you may fill it at a retail pharmacy initially. After that, you will need to order your medication through Accredo, Express Scripts’ specialty pharmacy. Specialty medications are those used for chronic or complex disease states such as: Hepatitis, Multiple Sclerosis, Growth Hormone Deficiency, Rheumatoid Arthritis, Infertility, Hemophilia, and Oncology.
RETAIL STORE DISCOUNT PROGRAMS
Only maintenance drugs purchased through the Windstream Plan must use mail order. Although the retail store may provide prescription information to Express Scripts, you always have the option of purchasing your prescriptions using Express Scripts or through a retail discount program. Ask your pharmacist which option is most affordable.
The Brand Exclusion program targets brand name medications that are not available as a generic. Instead, these brands have therapeutically equivalent generic alternatives available. Therapeutically equivalent means that these medications can be expected to produce essentially the same therapeutic outcomes. Brand exclusions are in place in the following therapy classes. If you choose a brand-name drug, you will be responsible for the full cost of the prescription even if you have met your deductible. Generic options are covered under the plan.
- Acne – topical with antibiotic
- Acne – topical
- Fenofibrates (e.g. for cholesterol treatment)
- Nasal antihistamines
- Nasal steroids
- Proton Pump Inhibitors (PPIs) (e.g. for gastric acid treatment)
- Statins (e.g. for cholesterol treatment)
- Sedative hypnotics
- Triptans (e.g. for migraine headaches)
In rare circumstances, use of the brand name may be medically necessary for treatment. In those cases, your physician may request a prior authorization by calling ExpressScripts at 866.804.7613.