2012 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 or log on to the mail order pharmacy website.
Pharmacy benefit for Purdue Incentive and Purdue Copay plans
The combined retail and mail order prescription drug out-of-pocket maximum is $1,300 per person/$2,600 per family per year for the Purdue Incentive and Purdue Copay plans. Once you have paid this amount in prescription drug costs during the year, the plan will pay 100 percent for the rest of the calendar year. Pharmacy costs do not count toward satisfying the deductibles or out-of-pocket maximums of your medical plan.
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.
Generic Drugs - You pay 20%
Preferred Brand Name Drugs - You pay 30%
Non-Preferred Brand Name Drugs - You pay 50%
Non-Covered Drugs - You pay the full cost; plan pays nothing.
Mail order pharmacy benefit:
Generic Drugs - You pay 15%
Preferred Brand Name Drugs - You pay 25%
Non-Preferred Brand Name Drugs - You pay 45%
Pharmacy benefit for the Choice Fund with HSA medical plan
Deductible Phase: You pay 100 percent of your medical and prescription drug expenses until you meet your combined medical/prescription annual deductible of $1,300/single and $2,600/family. Preventive generic medications are available for no charge during any phase of your insurance.
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 $3,300/single and $6,600/family.
100 Percent Coverage Phase: Once you’ve reach your combined out-of-pocket maximum, including your deductible, your health plan pays 100 percent of eligible medical and prescription drug expenses for the remainder of the benefit year.
Retail pharmacy benefit:
Generic - You pay 20% (unless the drug is preventive; then you pay nothing)
Preferred Brand Name Drugs - You pay 30%
Non-Preferred Brand Name Drugs - You pay 50%
Mail order pharmacy benefit:
Generic - You pay 15% (unless the drug is preventive; then you pay nothing)
Preferred Brand Name Drugs - You pay 30%
Non-Preferred Brand Name Drugs - You pay 50%
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 or through the Express Scripts formulary.
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. If you or your doctor decides that a drug on the non-preferred brand name drug list is the one you should use, the plan will pay 50 percent. However, you'll get a higher benefit if you and your doctor decide that a generic or preferred brand name will work for you.
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.