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2014 Prescription Drug Coverage for Purdue Medical Plans

Administered by Express Scripts (formerly Medco).

When you enroll in a Purdue medical plan, you can receive prescription medications through a retail pharmacy network or through the mail order program.

When you need a maintenance medication (one that is taken over a long period), you can take advantage of additional savings by using the mail order program. You can receive up to a 90-day supply of your medication conveniently delivered through the mail at a discounted price, and the plan will pay a higher level of benefits, too. This saves money for both you and Purdue.

Since your prescription will need to be delivered through the mail, you will need to allow time for your medication to arrive. If you have a new medication, you may need to ask your doctor to write two prescriptions — one for a 30-day supply that you can have filled right away at a retail pharmacy and one for a 90-day supply that you can send to the mail order program. You will not be able to receive a 90-day supply from the retail pharmacy.

Send your prescription to the mail order pharmacy service with a completed Mail Order Form and your copayment. To know how much copayment to include, call the mail order service for an estimate. You can expect to receive your medication in 10 to 14 days from the date you mail your order. For an additional charge, you can choose next-day or second-day delivery. Refills are even easier. You can either call the toll free number on your prescription label, 877-845-2795, or log on to the mail order pharmacy website.

To transfer current retail prescriptions to mail order, log on to the mail order pharmacy website and choose the medication(s) you want to transfer. Confirm the prescribing doctor information so that Express Scripts can contact your doctor about transferring the prescription to a 90-day mail order prescription. Once your doctor approves, you can expect ot receive your medication within 7-14 days. Be sure you have enough medication on hand before transferring to mail order.

Pharmacy benefit for Purdue Health Plan

  • No deductible applies to prescriptions on the Purdue Health Plan.
  • In addition, preventive generic drugs are covered at 100 percent. Other generics, preferred brand name drugs and non-preferred brand name drugs apply to the out-of-pocket maximum. See the coverage levels below. 

Member Pays the Difference: If a generic equivalent drug is available, but you choose to use a brand name drug, you'll pay the difference between the cost of the brand name drug and the generic drug. You'll also pay your plan's generic drug coinsurance. 

Retail pharmacy benefit:

To fill your prescriptions at participating pharmacies, simply show your prescription card at the pharmacy and pay your percentage of the drug's cost. No deductible applies. You have no paperwork to file; the pharmacy will handle your claim.

  • Preventive Generic Drugs - You pay $0
  • Generic Drugs - You pay actual cost up to a $10 maximum
  • Preferred Brand Name Drugs - You pay 30% up to a $100 maximum
  • Non-Preferred Brand Name Drugs - You pay 40% up to a $150 maximum

Mail order pharmacy benefit: 

  • Preventive Generic Drugs - You pay $0
  • Generic Drugs - You pay actual cost up to a $25 maximum
  • Preferred Brand Name Drugs - You pay 30% up to a $250 maximum
  • Non-Preferred Brand Name Drugs - You pay 40% up to a $350 maximum

Pharmacy benefit for Purdue Health Plan Plus HSA 1 and
Purdue Health Plan Plus HSA 2

  • Preventive generic medications are available for no charge during any phase of your insurance.
  • Brand name preventive medications are not subject to your deductible. You will pay only the applicable coinsurance and "Member Pays the Difference" portion.

Deductible Phase: You pay 100 percent of your medical and prescription drug expenses until you meet your combined medical/prescription annual deductible of:

  • Purdue Health Plan Plus HSA 1: $1,750 employee only or $3,500 employee plus one or more covered family members OR
  • Purdue Health Plan Plus HSA 2: $2,500 employee only or $5,000 employee plus one or more covered family members  

Coinsurance Phase: Once you’ve met your annual deductible, you pay the coinsurance amounts listed below until you reach your combined medical/prescription out-of-pocket maximum of:  

  • Purdue Health Plan Plus HSA 1: $3,500 employee only or $7,000 employee plus one or more covered family members OR
  • Purdue Health Plan Plus HSA 2: $5,000 employee only or $10,000 employee plus one or more covered family members  

100 Percent Coverage Phase: Once you’ve reach your combined out-of-pocket maximum, which includes your deductible, your health plan pays 100 percent of eligible medical and prescription drug expenses for the remainder of the benefit year. 

Member Pays the Difference: If a generic equivalent drug is available, but you choose to use a brand name drug, you'll pay the difference between the cost of the brand name drug and the generic drug. You'll also pay your plan's generic drug coinsurance. 

Retail pharmacy benefit:

  • Preventive Generic Drugs - You pay $0
  • Preventive Preferred Brand Name Drugs - You pay 35%
  • Preventive Non-Preferred Brand Name Drugs - You pay 55%
  • Generic - You pay deductible, then actual cost up to a $10 maximum
  • Preferred Brand Name Drugs - You pay deductible, then 35%
  • Non-Preferred Brand Name Drugs - You pay deductible, then 55%

Mail order pharmacy benefit:

  • Preventive Generic Drugs - You pay $0
  • Preventive Preferred Brand Name Drugs - You pay 25%
  • Preventive Non-Preferred Brand Name Drugs - You pay 45%
  • Generic - You pay deductible, then actual cost up to a $25 maximum
  • Preferred Brand Name Drugs - You pay deductible, then 25%
  • Non-Preferred Brand Name Drugs - You pay deductible, then 45%

Drug categories for all three medical plans

To determine pricing and which category a specific medication falls within, visit the Express Scripts website.

Generic preventive drugs

Generally, preventive drugs are prescribed to prevent the occurrence of a disease in someone who has developed risk factors or to prevent the reoccurrence of a disease from which the individual has recovered. Generic forms of these medications are covered at 100 percent by all Purdue medical plans.

Generic drugs

When a drug company's patent on a particular drug expires, other companies are then free to begin producing the exact same drug, but can't use the original brand name. The other companies refer to the drug by its chemical, or generic, name. Generic drugs contain the exact same active ingredients as the brand name drug and must pass U.S. Food and Drug Administration standards for safety and effectiveness. Generic drugs generally cost 25 percent to 60 percent less than the brand name equivalent. Using generics saves money for you and the medical plan.

Preferred brand name drugs

Drugs on the preferred list are brand names that have been identified as excellent values, both clinically and financially. Before a drug can be designated as a preferred brand name, a committee of independent doctors and pharmacists evaluates the drug to be sure it meets standards for safety, effectiveness, and cost.

View the preferred brand name status of drugs by logging into the Express Scripts website.

Non-preferred brand name drugs

Some brand name drugs cost more than others, even though they have the same therapeutic effects as less expensive brand name drugs. These more expensive drugs are on the “non-preferred brand name drug” list.

Non-covered drugs

Some drugs are not covered. These are often drugs that the U.S. Food and Drug Administration has found to be totally identical to another drug on the market.

Contraceptives

As mandated by the Affordable Care Act, generic contraceptives approved by the Food and Drug Administration will be covered at 100 percent. For information about these, go to the Express Scripts website.