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Prescription Drugs

Express Scripts is the pharmacy benefits manager for the prescription drug benefits for State Group health insurance plans (except the CHP Retiree Advantage plan and the FHCP Medicare Advantage plan).

  • Prescription Drug Plan members can log into express-scripts.com to check the status of an order, see prescription drug history, check for generic alternatives, order mail-order refills and use many other features. Members can also call (877) 531-4793 to speak with a Member Services representative.
  • PPO Plan members should review Express Scripts' Maintenance Drug List to see which prescriptions must be filled at mail order after three fills at a retail pharmacy.
  • Twice a year, Express Scripts updates its Preferred Drug List. Your prescription drug costs will vary based on whether the prescription drug is a generic, a preferred brand-name or a nonpreferred brand-name.

This chart shows the cost savings of using generics and mail-order for maintenance medications.

  Standard PPO and Standard HMOs Health Investor HMO and PPO

 

Retail
(up to a 30-day Supply)

Mail Order Program
(up to a 90-day Supply)

Retail and Mail Order*

Generic

$7

$14

30%

Preferred Brand-Name

$30

$60

30%

Nonpreferred Brand-Name

$50

$100

50%

 

Get More for Less - Use Mail Order!

Use the mail-order pharmacy to receive up to a 90-day supply of medication for the same cost as two 30-day prescriptions (a 60-day supply) at a retail pharmacy.

 


 

Go Mobile!

Download Express Scripts' smartphone app to manage your account, see your ID card and more.

 

*Member cost of prescription after satisfying the appropriate individual or family annual deductible.

If you request a preferred brand-name drug when a generic is available, you must pay the difference between the generic cost and the preferred brand-name cost, plus the appropriate copayment or coinsurance. If your physician writes on the prescription that the preferred brand-name drug is medically necessary or "dispense as written" and the reason, you pay only the appropriate copayment or coinsurance.

Prescription Drugs - What's the Difference?

Generic medications may look different, but they provide the same level of quality, safety, and effectiveness as the brand-name medicine for a lower price.

Often two brand-name drugs (not generic) can be used for the same medical condition. One may be less expensive than the other. The less-expensive drug becomes a preferred brand-name drug, and the other becomes a nonpreferred brand-name drug. Check Express Scripts' Preferred Drug List periodically; it's updated twice a year. Sometimes a drug moves from the preferred brand list to the nonpreferred list. If this happens, ask your doctor to prescribe a preferred brand-name drug or generic drug that would cost less money and work just as well.


Important Information for Retirees Regarding Medicare Part D and the State Employees' Group Insurance Program

  • Medicare Part D Prescription Drug Plans began January 1, 2006.
  • The State Employees' Group Insurance Program prescription drug benefit is as good as or better than the Medicare Part D requirements.
  • Canceling health coverage under the State Employees' Group Insurance Program will cancel both health and prescription drug benefits.
  • If individual retirees cancel coverage under the State Employees' Group Insurance Program, they will not be allowed to re-enroll at a later date.
  • The State Employees' Group Insurance Program will supplement the prescription drug benefits received through Medicare Part D as secondary coverage if a retiree additionally enrolls in a Medicare Part D plan.

View a copy of the state's Medicare Part D Notice of Creditable Coverage.

For more information on Medicare Part D, please visit the Center for Medicare and Medicaid Services at http://www.cms.hhs.gov/PrescriptionDrugCovGenIn/