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IMPORTANT: If you do not elect your benefits during the annual Open Enrollment period or within 31 days of your date of hire, you will not have Roper St. Francis Healthcare health plan coverage until the next year unless you have a qualified life event as defined by the IRS.
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Your 2019 Prescription Drug Coverage
Express Scripts® is the pharmacy benefits administrator for all Roper St. Francis Healthcare medical plans. Your prescription drug plan will correspond with the medical health plan you elect during your enrollment. You will receive an ID card in the mail from Express Scripts prior to January 1, 2019.
You have a choice to fill your generic maintenance medications at a local retail pharmacy (30-day supply) or receive them at home (90-day supply) through delivery from the Express Scripts PharmacySM.
Maintenance brand drugs will need to be filled for a 90-day supply through the Express Scripts Pharmacy, after three retail refills. Please see “Maintenance Brand Refills” below for more information.
How to use your prescription drug coverage
Retail: Starting January 1, 2019, present your pharmacy beneﬁt card with your prescription at your local retail pharmacy to automatically receive your beneﬁts. You will pay the applicable co-pay or deductible/coinsurance amount, depending upon the health plan you have selected. Have a question? Beginning October 17, you can call 1-844-730-1971.
Home Delivery: Starting January 1, 2019, you can fill your medication by choosing one of these options. Please allow 10-14 days for your first prescription to be shipped:
- Ask your provider to request a 90-day prescription that he or she can ePrescribe directly to Express Scripts.
- Print a mail order form by selecting “Forms & Cards” from the menu under “Benefits” after registering on the Express Scripts website at express-scripts.com. Complete the form and follow the mailing instructions.
- Call Express Scripts and they’ll contact your provider for you.
Injectables/Specialty: Starting January 1, 2019, injectable/specialty drugs must be obtained through Accredo, the Express Scripts specialty pharmacy.
Beginning October 17, you can visit www.express-scripts.com/roperstfrancis to find a complete list of pharmacies and covered medications.
|Alliance Prime||Alliance Flex||Alliance Save||Alliance Out-of-Area|
|Deductible and Out-of-Pocket Limit-Pharmacy|
|Annual Pharmacy Deductible||N/A||N/A||Included in medical deductible||N/A|
|Annual Pharmacy Out-of-Pocket Limit||$1,200 teammate/ $2,400 family||$1,200 teammate/ $2,400 family||Included in medical out-of-pocket maximum||$1,200 teammate/ $2,400 family|
|Using a Retail Pharmacy|
|Generic||$10||$10||You pay 30% after deductible||$10|
|Brand*||$35||$35||You pay 30% after deductible||$35|
|Non-preferred Brand*||You pay 40% ($50 min/ $150 max)||You pay 40% ($50 min/ $150 max)||You pay 30% after deductible||You pay 40% ($50 min/ $150 max)|
|Mail Order (90-day Supply)|
|Generic||$20||$20||You pay 30% after deductible||$20|
|Brand||$87.50||$87.50||You pay 30% after deductible||$87.50|
|Non-preferred Brand||You pay 40% ($125 min/ $375 max)||You pay 40% ($125 min/ $375 max)||You pay 30% after deductible||You pay 40% ($125 min/ $375 max)|
|Specialty Drugs (Injectables)|
|Self-injectables through 4D Pharmacy||$50 (30-day supply)||$50 (30-day supply)||You pay 30% after deductible||$50 (30-day supply)|
|Specialty Drugs with Limited Distribution||$150||$150||You pay 30% after deductible||$150|
Maintenance Brand Refills:
* You will be able to get your maintenance brand drug at a retail pharmacy three times at your regular co-pay/coinsurance. Beginning with the fourth fill obtained at a retail pharmacy, you will pay 100% of the cost of the drug. In order to continue receiving benefits, you must switch to a 90-day prescription and fill through home delivery from the Express Scripts Pharmacy. Beginning October 17, maintenance brand-name drugs can be identified by visiting www.express-scripts.com/roperstfrancis and searching for your medication or calling Express Scripts at 1-844-730-1971.