Prescription drug program
Does the prescription drug deductible apply to the medical plan deductible?

No. The prescription drug deductible is separate from the medical plan deductible and must be met before your prescription drug copays apply. For example, if you enroll in the Consumer Plus option and have a prescription for a formulary brand-name drug with an actual price of $120, you first pay your $50 annual deductible ($120 - $50 = $70) and then your $40 retail copay ($70 - $40 = $30), and then the plan pays the remaining $30. Once you pay the $50 deductible amount, you only pay the appropriate copay for each prescription for that covered person for the rest of the year.

There’s no separate prescription drug deductible for the Open Access option or the Select plan.

What’s a preferred drug?

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.

What should I do if my doctor prescribes a drug that isn’t on the preferred drug list?

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.

What if I can’t take a preferred brand-name prescription for medical reasons?

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.

How can I save money on prescription drugs?

To keep your costs down, you should:

  • Use in-network pharmacies
  • Ask your doctor to prescribe generic drugs or drugs that are on the preferred drug list
  • Use the mail service or Smart90 retail partners for maintenance prescriptions
  • Use a health care flexible spending account (FSA) when appropriate

 

Using the health care flexible spending account (FSA) can save you money. If you’re taking maintenance medications, you can estimate:

  • That you typically need to see your primary care physician (PCP) or specialist at least once a year
  • 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.

Why should I use a generic drug?

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.

Can I really get some generic drugs for free?

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.

How does the Smart90 program work?

You can get long-term, maintenance medications in one of two ways—through mail order or by going to any of Express Scripts’ retail partners. No matter which option you choose, your copay remains the same. You can still get two 30-day supplies of newly prescribed maintenance medications at any network pharmacy. After that, you can save money by ordering a 90-day supply through Express Scripts, delivered either by mail or to one of their retail partner locations. Be sure to ask for a 90-day prescription from your physician to qualify for the lower cost.

What should I know about prior authorization and managed drug limitations?

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.

Do I get an Express Scripts member ID card?

If you enroll in one of HISD’s Medical plan options, you receive both a medical ID and an Express Scripts ID. To protect your privacy, the Express Scripts ID uses a unique ID number that’s not your Social Security number. If you enroll in the Discount Rx program, you receive an Express Scripts ID card in your Prescription Drug Benefits Kit two to three weeks after enrollment.

What about specialty drug prescriptions?

We’ve also added a specialty medication tier to the prescription plan. For all specialty drugs, which are only available in a 30-day supply, use the Express Scripts specialty mail-order pharmacy, Accredo.

For any benefits question or concern, one call does it all.
Call us at 877-780-HISD (4473)

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