Medco prescription drug plans

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.

Source: http://www.psrsstl.org/media/540/2012_ESI_Prescription_Drug_Plans_(Copayment_Sheet)2sided.pdf