You are automatically enrolled in the prescription drug plan administered by Express Scripts (formerly Medco) when you enroll in one of the medical options.
The prescription drug plan provides retail and mail services. Under the retail network service, you can visit any in-network pharmacy for your short-term prescription drug needs. For a 30-day drug supply, the following co-payments apply:
- $5 for generic drugs
- $30 for preferred brands (See Preferred Drug Formulary)
- $45 for non-preferred brands
- $100 for specialty drugs (See Specialty Drug Formulary)
If you visit an out-of-network pharmacy, you must pay the prescription drug cost in full and then file a claim for reimbursement. Express Scripts (formerly Medco) will reimburse the cost of the prescription drug minus the applicable co-payment.
The mail service program must be used for maintenance or long-term medications. This will save you time and money, as you will receive a 90-day supply delivered to your home for the following co-pays:
- $12 for generic drugs
- $60 for preferred brands
- $90 for non-preferred brands
- $200 for specialty drugs (when clinically appropriate)
Mail Service Requirement: You may receive your first three refills for long-term or maintenance medications under the retail network service. Your fourth and future refills must be obtained through the mail service to avoid higher co-payments. Long-term or maintenance medications filled at retail after the first three refills will be subject to double the retail co-payments for up to a 30-day supply ($10 for generic, $60 for brand, or $90 for brand non-formulary). However, 90-day supplies may be filled at the Notre Dame Wellness Center at the mail-order co-payment amounts.
Medco offers participants several online services such as:
- Benefit plan information
- Coverage comparisons on home delivery, retail brand-name, and generic medications
- Online prescription orders, tracking prescription status, and viewing up to 18 months of prescription history.
Generic Drug versus Brand-Name Drugs
Generic Drugs: Generic drugs are chemically identical to brand name drugs, but are sold under their chemical generic name. Generic drugs must contain the same active chemical ingredients and be equivalent in strength and dosage form to the brand-name product. The federal Food and Drug Administration regulates the quality, strength, and purity of generic drugs.
Brand-Name Drugs: Brand-name drugs that are advertised and sold under a product name chosen by the manufacturer. In general, brand-name drugs are more expensive than generic drugs.
Preferred Drug Changes
|Brand Name (generic name)||Use(s)||Effective Date|
|Cafergot® **||Treatment of migraine headaches||04/28/11|
|Ceftin® 125 MG/5ML**||Treatment of bacterial infection||05/05/11|
|Safyral||Prevention of pregnancy||05/06/11|
|AndroGel® 20.25/1.25||Treatment of deficiency or absence of endogenous testosterone||05/10/11|
|Halaven™||Treatment of patients with metastatic breast cancer who have previously received at least two chemotherapeutic regimens for the treatment of metastatic disease||05/18/11|
|Natroba||Treatment of head lice||05/18/11|
|Glycopyrrolate Tab||Treatment of chronic severe drooling caused by neurologic disorders, also used for treatment of peptic ulcers||05/18/11|
|Hydroxyprogesterone Caproate Powder||Used to help reduce risk of having a preterm baby||05/18/11|
|Mononine® Kit||Treatment of hemophilia B||06/08/11|
|Lida Mantle HC 0.5%-3% Cream**||Treatment of pain, itching, soreness, and discomfort of the skin or mucous membranes||06/15/11|
|Makena™||Used to help reduce risk of having a preterm baby||06/17/11|
|Amturnide||Treatment of hypertension||07/01/11|
|Fenoglide||Treatment of high cholesterol||07/01/11|
|Uloric||Treatment of hyperuricemia in patients with gout||07/01/11|
|Menopur®||Development of multiple follicles and pregnancy in the ovulatory patients participating in an ART program||07/08/11|
|Lysteda™||Treatment of cyclic heavy menstrual bleeding||07/08/11|
|Brand Name (generic name)||Use(s)||Effective Date||% of Members Affected||Reason|
|Antabuse 250 MG||Treatment of alcoholism||04/26/11||0.01%||Generic Available|
|Femara®||Treatment of breast cancer||04/29/11||0.03%||Generic Available|
|Concerta®||Treatment of Attention Deficit Hyperactivity Disorder (ADHD)||05/10/11||0.33%||Generic Available|
|Carbatrol®||Treatment of epilepsy||05/27/11||0.03%||Generic Available|
|Furadantin®||Treatment of urinary tract infections||06/07/11||0.00%||Generic Available|
|Adoxa® 150 MG, TAB||Treatment of bacterial infections||06/10/11||0.02%||Generic Available|
|Nasacort® AQ||Treatment of allergic rhinitis||06/21/11||0.17%||Generic Available|
|Levaquin® TAB, Oral Solution||Treatment of bacterial infections||07/01/11||0.85%||Generic Available|
|Entocort® EC||Treatment of mild to moderate Crohn’s disease||07/01/11||0.04%||Generic Available|
|Skelaxin®||Treatment of acute, painful musculoskeletal conditions||10/01/11||0.03%||Contractual Decision|
The Prescription Drug plan includes a formulary, which is a list of preferred drugs. This list includes a wide selection of drugs offering you choices while keeping benefit costs affordable. Each drug is approved by the Food and Drug Administration (FDA) and reviewed by an independent group of doctors and pharmacists for safety and effectiveness.
Specialty Drugs & Medications (click here for a list of specialty drugs)
Specialty medications are drugs that are used to treat complex conditions, such as cancer, growth hormone deficiency, hemphilia, hepatitis C, immune deficiency, multiple sclerosis, and rheumatoid arthritis. Whether they are administered by a healthcare professional, self-injected, or taken by mouth, specialty medications require an enhanced level of service.
Over the past several years, specialty drugs have been introduced in the marketplace. Currently there are several hundred specialty drugs in the drug pipeline pending FDA approval for release in the next few years. Specialty drug spending is one of the fastest growing components of our pharmaceutical drug costs. Because of this, we have been partnering with Accredo Health Group Inc., Express Scripts’ specialty pharmacy, to provide services for our members, which will provide benefit consistency and consistency in the application of clinical protocols.
Accredo is dedicated to serving the needs of patients living with complex conditions that require specialty medications. Accredo provides:
- Enhanced clinical training, privacy and support
- 24/7 access to specialized nurses and pharmacists
- Access to products and services
- Compliance monitoring and side-effect mentoring
- Refill reminders
- Benefit consistency
- Shipping convenience
If you or a family member are prescribed a specialty medication, Accredo may be reaching out to
you and your physician.