Express Scripts Prescription Drug Plans For Members with UnitedHealthcare POS Plans Effective January 1, 2012
You must use a pharmacy in the Express Scripts network. Prescription drug copayments are identified below. UnitedHeathcare Base Plan
Retail Benefit Up to 90-Day Retail (up to the lesser of 31-day supply or 100 units) or Mail Order Benefit Cost of prescription Member copayment Cost of prescription Member copayment Drug to the plan Drug to the plan UnitedHeathcare Buy Up Plan
Retail Benefit Up to 90-Day Retail* (up to the lesser of 31-day supply or 100 units) or Mail Order Benefit Cost of prescription Member copayment Cost of prescription Member copayment Drug to the plan Drug to the plan
Note: Member will pay the lesser of the copayment amount or the cost of the prescription drug to the plan.
Coordination of prescription drug benefits for Medicare members
The SLPS prescription drug plan is secondary to other drug coverage for covered members and their dependents, pursuant to the provision of the plan (for example, it is secondary to Medicare Part D). Notwithstanding the foregoing and until the Board of Education determines it can administer secondary drug coverage, the SLPS prescription drug plan will pay as primary. The Board reserves the right to change this method of administration on a prospective basis at any time, should it receive notification that a covered member has other drug coverage. If notification is received that the member has other drug coverage, including under Medicare, the SLPS prescription drug plan will pay as secondary an recover any cost which should have been paid secondary back to the date of secondary coverage. See reverse for additional Pharmacy Plan information. SLPS Pharmacy Benefit Program for United HealthCare POS Plans Administered by Express Scripts Applies to non-Medicare and Medicare Eligible Retirees, Survivors, and Dependents Over-the-Counter (OTC) Program
The prescription drug plan will provide a voluntary prescription drug savings program that allows
members the option of replacing high cost brand drugs with over-the-counter (OTC) and generic
alternatives. The OTC program will cover over-the-counter equivalents of high cost and highly utilized drugs in the following three drug classes: PPI’s (acid reducers, e.g. “Nexium”); NSAID’s (non-steroidal anti-inflammatory drugs, e.g., “Celebrex”); and Antihistamines (e.g., brand drug Clarinex; OTC drug
Claritin). The program will feature a zero ($0) co-pay for members able to use an OTC alternative with a physician’s prescription.
Mandatory Generic Provision and Annual Prescription Drug Deductible Applies to Medicare Eligible Retirees, Survivors, and Dependents Mandatory Generic
You will be responsible to pay the cost difference between the brand-name drug and its generic equivalent plus the applicable co-payment if you receive a brand-name drug when a generic equivalent is available (even if your physician indicates “Dispense as Written”).
Please keep in mind that the generic version of a drug is made from the same chemical compound as its
brand-name counterpart. Generic drugs are manufactured according to the same standards as brand-name drugs and have the Food and Drug Administration’s (FDA) approval for safety and effectiveness, yet generic drugs cost a fraction of the price of their brand-name counterparts. The use of generic drugs
offers a simple and safe alternative to help reduce your medication costs.
We encourage you to discuss generic alternatives with your physician. If your physician believes a
change in your prescription to a generic alternative is appropriate, ask your physician to call your
pharmacy and change your prescription. For new prescriptions, you can ensure that you will receive the
generic product when it is available by asking your physician to write your prescription by the generic or
Drug Plan Deductible
The prescription drug plan added an individual deductible of $300 beginning January 1, 2007. A
deductible is the amount you are required to pay before your co-pays “kick in.” In other words, you will
pay 100% of the cost of your medications until your deductible is met. If the cost of your medication is
greater than your deductible, you will be required to pay your deductible in addition to the applicable co-payment remaining for that particular “fill” of that medication. Once you have met your individual deductible, you will only need to pay the applicable co-payment for medications that you have filled.
Your $300 deductible applies at retail, mail service, OTC Program, and Express Scripts and will “reset”
every January 1st. For the Over-the-Counter (OTC) Program, after your deductible has been met, there is
a $0.00 co-pay for the OTC listed medications with a physician’s prescription.
See reverse for additional Pharmacy Plan information.
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