Prescription Drug Information
All of Rice’s medical plan options cover prescription drugs through our Pharmacy Benefit Manager (PBM), Express Scripts (ESI). To access pharmacy benefits, employees should provide their Aetna ID card to the pharmacist and direct the pharmacist to the information on the back of the card. The Aetna ID number is also the pharmacy ID number. In the event that an employee has not received their Aetna ID card, or only printed the front of it, the necessary information is listed below.
Prescription drug benefits features a formulary drug list. A “formulary” is a list of medications organized into groups or “Tiers.”
|Formulary Tier Definitions|
|Tier One (1)||Most Generics|
|Tier Two (2)||Preferred (also called formulary) medications. These are on the preferred medications list.|
|Tier Three (3)||Non Preferred medications not on the preferred list|
|Tier Four (4)||Specialty Medications|
While the Rice plan uses ESI’s National Preferred PSG (with Exclusions) as the basis for the tiers (http://lab.express-scripts.com/lab/insights/drug-options/2017-national-preferred-formulary), there are some exceptions. In addition, this list is not exhaustive. For the most accurate information about all coverage for medications, employees should register and log on to Express-Scripts.com. Use the “price a drug” tool to find out what tier the drug is, and how much it will cost. ExpressScripts customer service representatives are available at 1-800-363-9019.
Copays and Coinsurance
Copays and coinsurance, the portion of the drug cost that you are responsible to pay, are listed for all of the Aetna plans in the table below. Please note the below reflects the cost-share that is effective July 1, 2019.
|30-Day Retail||90-Day Mail Order|
|Tier 1||Tier 2||Tier 3||Tier 4||Tier 1||Tier 2||Tier 3|
|Your Cost||$10.00||$40.00||$60.00||25% up to $150.00||$25.00||$100.00||$150.00|
The Express Scripts network includes over 65,000 retail location representing all major chains (such as CVS, Walgreen's, Kroger, HEB, Target, and Wal-Mart) as well as many independent pharmacies throughout the United States. Simply present your Aetna ID card (with Express Scripts information on the back of it) and your prescription to a participating pharmacy.
Benefits are available only through a network pharmacy. If your pharmacy is not in the network, you can submit a request to add that pharmacy to the network through the benefits department at email@example.com.
At the time of service, you must pay the required copayment (your portion of the cost of the medication) or if you are on the High Deductible plan, your deductible and then your copayment. To access our Pharmacy Locator, please log into www.express-scripts.com and select "Find a Pharmacy" under the "Prescriptions" menu. You may also call the Express Scripts Customer Service at 1-800-363-9019.
Dispense as written requires that if a generic drug is available for your prescription, the prescription will be filled with the generic. If you request the brand, you will be charged both the difference in the actual cost of the generic and brand name drug, and the brand name copay. If it is medically necessary for you to use the brand name medication, your doctor may specify that request by 1. Writing for the brand name and 2. writing dispense as written. If these two criteria are met, you will pay the applicable brand copay only.
Maintenance drugs are medications prescribed for chronic, long-term conditions and are taken on a regular, recurring basis. Examples of chronic conditions that may require maintenance drugs are: high blood pressure, high cholesterol, and diabetes. Your pharmacist will inform you when the plan requires you to purchase your maintenance medication at 90 days.
For convenience, and so that you can be sure that your medication and dosage is appropriate for new prescriptions, you may fill a 30 day prescription up to two times at a retail pharmacy. Thereafter, maintenance medications must be filled using 90-day supplies. You can do this at a retail pharmacy or use the mail order program through Express Scripts. Be sure to ask your doctor for a 90 day prescription with the appropriate number of re-fills for your maintenance drugs.
We are pleased to provide mail order services through Express Scripts mail order.
Mail order is an excellent way to receive prescriptions you will be taking on a regular basis with no worries about availability of supply at the local pharmacy. In addition, mail order saves you money as you receive a 90-day supply for the price of a two and one half 30-day supplies. For individuals who are taking ongoing maintenance medications, you may want to consider utilizing the mail order service for the convenience of home or office delivery. When using mail order, shipping is free, it is easy to pay, and you can even set up an extended payment program to make paying for a 90-day supply even easier.
Please visit Express-Scripts.com for more information on mail order, or call them at 1-800-363-9019.
When you need a new prescription, your physician can write you one prescription for 90 days with 3 refills, and that will take care of you for the year. You can mail in that prescription with a mail order form available online at Express-Scripts.com or your doctor can e-scribe the prescription to Express Scripts or fax it to them. You must register at Express Scripts for the mail order, and give them your preferred method of payment.
If you have an active medication at the retail pharmacy, and want to transfer it to home delivery, simply register on Express-Scripts.com and follow the steps to "transfer to home delivery".
Specialty drugs are usually high-cost prescription medications used to treat complex, chronic conditions like cancer, rheumatoid arthritis and multiple sclerosis. Specialty drugs often require special handling (like refrigeration during shipping) and administration (such as injection or infusion). Patients using a specialty drug often must be monitored closely to determine if the therapy is working and to watch for side effects.
Espress-Scripts uses Accredo Specialty Pharmacy as the exclusive provider for specialty medications as part of your prescription drug plan. What this means is that you and your family will receive the personalized care and expertise of Accredo's Specialty Pharmacy pharmacists, which is essential to successful prescription therapy. This is because Accredo Specialty Pharmacy goes beyond traditional retail pharmacy, helping you get the most from your specialty medication therapy.
Because specialty medications can be more difficult to manage, Accredo Specialty Pharmacy offers the following patient support services at no charge:
- Personalized support to help you achieve the best results from your prescribed therapy.
- Convenient delivery to your home or physician's office.
- Easy access to a team who can answer medication questions, provide educational materials about your condition, help you manage any potential medication side effects, and provide confidential support—all with one toll-free phone call.
- Assistance with your specialty medication refills.
- Specialty medications can be very expensive. If you find that your specialty medications are stretching your budget to the breaking point, your Accredo specialty pharmacist may have access to a copay assistance program to help you out. These programs are made available in certain circumstances by the drug manufacturer.
You can access the Accredo specialty pharmacy the same way you access all other medications through Express-Scripts by logging on to Express-Scripts.com or by calling toll-free 1-800-363-9019.
Your prescription drug information can be found of the back of your Aetna ID card. Should you misplace your ID card and you need your covered prescriptions immediately, please take the following information (along with the Aetna temporary ID you can print when your log into Aetna Navigator) to the pharmacy and present it to the pharmacist:
- BIN: 003858
- PCN: A4
- Rx Group Number: RICEUNI
Should you have problems with your prescription claim, please ask the pharmacist to contact the Express Scripts Help Desk at 1-800-922-1557 or contact your Benefits Team.
How does the 90-day retail prescription drug program work?
The medical plan provides for purchase of 90-day maintenance prescriptions at retail pharmacies which accept Express Scripts coverage, which includes all of the major pharmacy and supermarket chains in the United States. You will pay for the 90 day prescription (at 2.5 times the 30 day cost) and receive the full 90-day supply in one transaction. As with a 30 day prescription, it is possible that the pharmacy may run out of a medication, but if that happens, they will send you home with the quantity they have in-stock, and you will be able to pick up the remainder of the order when the pharmacy re-stocks the medication, usually within a day or so. Both retail pharmacy and mail order services are available for you to fill your 90 day prescriptions.
Retail pharmacies will fill maintenance prescriptions of 30 days for two one-month cycles only; thereafter you must begin to purchase maintenance drugs in 90-day increments.
What is a maintenance medication? How will I know if I am required to get a 90 day supply?
Maintenance drugs are medications prescribed for chronic, long-term conditions and are taken on a regular, recurring basis. Examples of chronic conditions that may require maintenance drugs are: high blood pressure, high cholesterol, and diabetes. Your pharmacist will inform you when the plan requires you to purchase your maintenance medication at 90 days or you can call Express-Scripts at 1-800-363-9019, and they can tell you if your medication requires a 90 day fill.
Will certain drugs for chronic conditions still be covered at $0 copays, even though they are purchased for 90 days?
We happily did the math, and 2.5 times $0 is still $0. As part of our plan’s effort to help employees manage certain long-term medical conditions, certain generic drugs used to control high blood pressure, cholesterol, diabetes and asthma will continue to be available for the $0 copay.
Please explain Dispense As Written.
Rice's dispense as written requirement provides that if your physician writes for a brand drug and a generic is available, your prescription will be filled with the generic. If you request a brand drug instead of the generic, you will be charged both the difference in the actual cost of the generic and brand name drug, and the brand name copay. If your physician determines that it is medically necessary for you to use a brand drug, he or she can write a prescription that includes: 1) the brand name prescribed, and 2) direction to “dispense as written,” and you will be able to purchase the drug for the applicable brand copay.
Please contact us if you have other questions. Call 713-348-2363 (BENE) or email us at firstname.lastname@example.org.
Keeping your medications safer and more affordable is a priority for our pharmacy program. That is why when you are prescribed certain medications, your pharmacist may tell you that it requires prior authorization. This means that Express Scripts needs more information to make sure the prescribed medicine will work well for you and your condition, and to make sure it is covered by the plan.
Only your doctor can provide the necessary information for a prior authorization. There are several ways to do this.
- Your doctor can call 1-800-753-2851 and provide the necessary information over the phone.
- Your doctor can provide the needed information online with Express Scripts
- Your doctor can provide the needed information through E-prescribe, a special electronic prescribing tool.
- You can call 1-800-753-2851 with your doctor's name, address, fax number, and phone number and request that ESI reach out to your doctor to request the needed information.
For FAQs on Prior Authorization, click here.
Step Therapy simply means making sure you get safe, effective medicine for your condition-at the lowest possible cost for you and for Rice.
Often there are several different medications that can be used to treat a condition. Step therapy requires you to try the ones that are lower cost, often generics first, to see if they work for you. This is step one. If step one does not work, then a step two medicine can be tried. Depending on the medication, there can be several steps before you are approved for the medication originally written, and often a step one or two medication works well to treat a given condition, making the more expensive medication unnecessary.
For FAQs on Step Therapy, click here.