Prescription Drug Coverage for Pre-Medicare Plans

You will automatically be enrolled in the prescription drug program that is administered by OptumRX when you enroll in one of the Pre-Medicare medical programs offered to retirees of the University.

The prescription drug program provides retail and home delivery services. Under the retail feature, you can visit any in-network pharmacy for your short-term (30-days or less) prescription drug needs. A 30-day drug supply requires a co-payment of $5.00 for generic drugs, $20.00 for preferred brand, $35.00 for non-preferred brands, or $100.00 for specialty brand drugs.

You can also order your ongoing medications through the cost-effective, home delivery service. Under this option, you can receive up to a 90-day drug supply after you pay a $12.00 co-payment for generic drugs, $45.00 co-payment for preferred brands, $75.00 co-payment for non-preferred brands, or $200.00 for specialty brand drugs when clinically approved.

Specialty Drugs (PDF)

You can also combine the retail and home delivery features by asking your medical care provider to write two prescriptions: one for a 30-day supply to meet your immediate needs and another for up to a 90-day supply (with refills up to one year) to meet your ongoing needs.

Definitions to Help You Understand Prescription Drugs

Generic Drugs vs. 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 to the brand-name product. Generic drugs are regulated by the Federal Food and Drug Administration to ensure the quality, strength, and purity of generic drugs.

Brand-Name Drugs: Brand-name drugs are 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.

Specialty Drugs: Prescription medications that require special handling, administration, or monitoring.

What is a Preferred Brand Drug?

A Preferred Brand Drug is a cost-effective solution to help you select prescription drugs for you and your family. The Preferred Brand Drug list is a continually updated list of preferred drugs selected by a panel of physicians and pharmacists. A drug on the Preferred list benefits members as it gives them access to valuable medications at a lower co-payment. Both generic and brand-name drugs that provide effective, safe, and appropriate drug therapies are listed on the formulary.

To see if a prescription drug is on the Preferred Drug List for Notre Dame visit the Express Scripts (formerly Medco) web site at www.express-scripts.com or contact customer service at 1-800-711-0917.

Diabetic Coverage:

With your insulin prescription and co-payment, you may also order a 30-day supply of the following Diabetic Supplies:

  • Alcohol Swabs
  • Lancets
  • Urine/Blood Test Strips & Tapes
  • Blood Glucose Testing Monitors
  • Insulin Syringes w/wo Needles

If you choose to order supplies separately from your insulin prescription, a separate co-payment will be applied for each supply ordered.

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