Overview

When you enroll in a DSM medical plan, you automatically receive prescription drug benefits through Express Scripts.

Plan Details

  High Option PPO Low Option PPO CDHP
Retail prescriptions (your cost for a 30-day supply)
Generic $15 $15 20% coinsurance after CDHP deductible
Preferred Brand $30 $30 20% coinsurance after CDHP deductible
Non-Preferred Brand 30% coinsurance ($50 minimum and $100 maximum) 30% coinsurance ($50 minimum and $100 maximum) 40% coinsurance after CDHP deductible
Mail order prescriptions (your cost for a 90-day supply)
Generic $37.50 $37.50 20% coinsurance after CDHP deductible
Preferred Brand $75 $75 20% coinsurance after CDHP deductible
Non-Preferred Brand 30% coinsurance ($125 minimum and $250 maximum) 30% coinsurance ($125 minimum and $250 maximum) 40% coinsurance after CDHP deductible
Out-of-pocket maximum for prescription drugs
(employee/employee + 1 dependent/family)
$1,200
$2,400
$3,600
$1,200
$2,400
$3,600
The medical and prescription drug out of pocket maximum is combined.

drug tiers

The cost of your prescription drugs depends on the tier of the medication:

  • Generic — Generic drugs contain the same active ingredients as their brand-name equivalents and meet the same federal standards for safety, but typically cost significantly less.
  • Preferred brand — Preferred brand-name prescription medications are favored by a prescription plan based on drug effectiveness and cost.
  • Nonpreferred brand — Nonpreferred brand-name prescription medications are not on a prescription plan’s favored list (or formulary) based on drug effectiveness and cost. Nonpreferred drugs still may be covered, but may require prior authorization and cost more.

Mail order

For ongoing maintenance medication, you can take advantage of the convenience and cost savings of using the mail order program.

Why use mail order:

  • Prescriptions are shipped to you for free — no waiting in line at the pharmacy.
  • You save money with a reduced cost for a three-month supply.
  • You can set up automatic refills.

Save money

The cost of prescription drugs is rising faster than many other health care services and supplies. But, there are ways for you to save on your cost of prescriptions.

  • Ask your doctor about generic medications. Generic medications are generally just as effective as brand name medications, yet the cost of generics is substantially lower, both for you and the plan. They typically cost between 30% and 75% less than brand-name drugs.
  • Use the plan’s mail order feature. If you regularly take medication to treat a chronic condition — such as an allergy, heart disease, high blood pressure, or diabetes — the mail order prescription program is a convenient and money-saving option for you.
Dispense as Written

If you enroll in the High Option PPO or Low Option PPO plan and a generic equivalent is available and you choose to receive the non-preferred brand name drug, you will pay the higher copay/coinsurance amount, plus the difference between the retail cost of the generic and the non-preferred brand name in addition to the copay/coinsurance. But if your physician prefers that you fill your prescription as a brand name and writes “dispense as written” (DAW) on the prescription, you will pay only the non-preferred brand copay/coinsurance.

alert iconImportant!

If your doctor prescribes maintenance medication (for 90 days or more), you may submit your prescription to the Express Scripts mail order program. You are not required to fill your maintenance prescriptions through mail order but if you choose not to, you must call Express Scripts at 1-866-851-0145 to opt out.

In most cases, your cost will be lower for mail order than purchasing your medication at the local pharmacy. You will pay the equivalent of 2.5 retail copays for a three-month supply. Some examples of maintenance prescriptions may include high blood pressure drugs, birth control pills and insulin.

Preventive Medication

Some prescription drugs and over-the-counter medications and supplements are covered at 100% with no copayment or deductible. For example, the plan covers aspirin at 100% to prevent cardiovascular disease for men age 45-79 or women age 55-79. A prescription is required. To find out more about which medications are considered preventive, see the Preventive Medications List on the Resources page.

Specialty drugs

Specialty pharmacies provide medications that are used to treat certain complex conditions. Express Scripts’ specialty pharmacy Accredo has established a network of retail pharmacies experienced in dispensing and monitoring these special medications. To learn more about the specialty pharmacy network, call Express Scripts’ specialty pharmacy Accredo at 1-866-851-0145.