No, not for the Memorial Hermann ACO and the Choice POS II plans. In these plans, the prescription drug deductible is separate from the medical plan deductible. There is no deductible for generic drugs. For brand-name drugs, you must meet your annual $200 per-person prescription plan deductible before your prescription drug copays apply.
For example, if you have a prescription for a preferred, brand-name drug with an actual price of $250, you first pay your $200 annual deductible ($250 - $200 = $50) and then your $40 preferred-brand copay, and then the plan pays the remaining $10 ($50 - $40 = $10). Once you pay the $200 deductible amount, you only pay the appropriate copay for every other prescription for that covered person for the rest of the year.
Yes, for the High Deductible Health Plan (HDHP). The HDHP has different prescription drug coverages. This plan has no copays nor does it include any no-cost prescription. The cost of the prescriptions are combined with medical plan costs to create one annual deductible of $5,000(individual)/ $10,000(family). Until the employee has met the $5,000 deductible (combining both medical and prescription charges), the employee must pay 100% of the cost of the prescription drugs as well as any medical charges. Once the employee has reached the deductible of $5,000/$10,000, all charges are then paid at 100%. That includes all medical as well as prescription costs.
To help district employees diagnosed with diabetes, high cholesterol, high blood pressure and asthma improve their quality of life through better maintenance of their conditions, the district offers reduced prescription benefit copays. Generic copays that are classified for use in the treatment of diabetes, high blood pressure (hypertension), high cholesterol (anti-hyperlipidemic) and asthma are $0 with no prescription drug deductible. The copay for preferred brand-name medication for diabetes and asthma is equal to other generic/preferred copays, and non-preferred brand-name copays remain the same.
The prescription drug program includes a preferred drug list (sometimes called a formulary). A preferred drug is a drug that meets a patient's clinical needs at a lower cost than other drugs. Preferred drugs are FDA-approved and selected for their safety, quality, effectiveness and cost efficiency. The preferred drug list is included in your Prescription Drug Benefit Kit and available on the Express Scripts website. This list is subject to change.
You might want to ask your doctor to look at the preferred drug list. He or she may not be aware of an equivalent drug that’s available on the Express Scripts preferred drug list. If you and your doctor still want the non-preferred drug, it’s covered, but at the higher non-preferred, brand-name copay, which is still a significant savings over paying the full retail price.
You pay the non-preferred brand-name copay under your medical coverage option. If you choose a brand-name drug when a generic alternative is available, you pay the brand-name copay plus the difference in cost between the generic and brand-name drug.
To keep your costs down, you should:
Using a health care flexible spending account (FSA) can save you money.
If you’re taking maintenance medications, you can estimate the monthly or annual cost of the drug. This makes it easy to set aside pre-tax dollars in the health care FSA to pay yourself back for these costs.
Using generic drugs can save you and the plan money. A generic drug is a copy of an original brand-name drug that many companies now manufacture. Substituting generic for brand-name generally has no side effects. If your doctor prescribes a brand-name drug, ask if there’s a generic alternative because generic drugs are generally less expensive. In addition, if you choose a brand-name drug when a generic alternative is available, you pay the brand-name copay plus the difference in cost between the generic and brand-name drug.
Yes. Copays are waived for generic medications that treat high cholesterol, hypertension and diabetes, including injectable insulin. Take advantage of the Smart90 network (see next question) to receive a 90-day supply through the one of the Smart90 retail partners, which include Kroger, HEB, Costco, Randalls, Sam's Club and Walmart.
If you use any pharmacy other than one of the Smart90 retail partners to fill your maintenance medications, after the first two fills, even for free generic drugs, you only receive a 30-day supply, but are charged the full 90-day mail order copay. This applies to the generic drugs used to treat high blood pressure, high cholesterol, asthma and diabetes.
The first two times you purchase a 30-day supply of a prescribed maintenance medication at a participating retail pharmacy, you pay your annual pharmacy deductible, if required, and your normal retail copay.
After that, you can save money by purchasing 90-day supplies of your maintenance medications through the Express Scripts mail service or at a local retail partner. These include Kroger, HEB, Costco, Randalls, Sam’s and Walmart. Ask your physician for a 30- day prescription for your initial fill(s) and a second prescription for a 90-day supply and refills for up to one year, if appropriate, so you can take advantage of these savings.
Katy ISD plans also cover women's generic contraceptives at 100%, as well as those that have no generic alternative.
Yes. You will receive a card in the mail from Express Scripts when you enroll in a medical plan. You may request an ID card for covered dependents age 18 and over. If you have questions or need additional cards, contact Express Scripts at 855-712-0333. Representatives are available weekdays, 8 a.m. to 6 p.m., except holidays.
The prescription drug plan doesn’t cover certain medicines without prior authorization for medical necessity. If you are currently using one of these drugs and don’t get authorization from your doctor, you may have to pay the full cost of your medication. Another option is to choose a generic or brand formulary alternative from Express Script’s standard formulary list. When you choose a drug from this list, you don’t have to get prior authorization.