Prescription Drug Benefits

Express Scripts Prescription Drug Coverage

Express Scripts provides prescription drug coverage for the BCBS Basic HSA, Advantage HSA, and Advantage PPO plans. You and Zebra share the cost of in-network and out-of-network prescriptions you receive throughout the year. Coverage includes free flu and shingles vaccines when you present your Express Scripts member ID card at any network pharmacy.

If you would like to model your prescription drug costs under the different Zebra health plan options prior to enrolling, visit the Express Scripts enrollment website.

Prescription Drug Benefit Summary

The chart below shows the prescription drug plan information for the Basic HSA, Advantage HSA, and Advantage PPO options.

Advantage PPO Plan

Under the Advantage PPO option, you do not need to meet the medical plan annual deductible before prescription drug benefits are received. In general, you will pay a $10 copay for your generic prescription or 20 percent of the cost of your non-generic prescription, and the plan will pay the rest. Minimum and maximum limits apply to the amount you pay, and those will vary depending on where you fill your prescription (retail pharmacy or mail order) and whether your drug is on the plan formulary (see chart below).

Prescription drug copays will accumulate and count toward a separate prescription drug out-of-pocket maximum. This is in addition to the out-of-pocket maximum that applies to your medical plan. Once the prescription drug out-of-pocket maximum is met, the plan will generally pay 100 percent of your prescription drug costs for the rest of the year.

If no generic equivalent exists or your doctor specifies the use of a brand name drug (and you have an approved authorization on file with Express Scripts), you will pay only the applicable brand name copay shown below.

Basic HSA and Advantage HSA Plans

You must satisfy the entire medical plan annual deductible before the plan pays benefits for prescription drugs. (You pay 100 percent of the cost of your prescriptions until you meet the annual deductible.) After you meet the deductible, the plan will pay 100 percent of the cost of generic drugs.

There is not a separate out-of-pocket maximum for prescription drugs. Medical and prescription drug costs accumulate toward the same out-of-pocket maximum.

If you purchase a brand name drug when a generic equivalent is available, you are responsible for paying the difference between the cost of the brand name drug and the generic. If no generic equivalent exists or your doctor specifies the use of a brand name drug (and you have an approved authorization on file with Express Scripts), the plan will pay the full cost of the brand name drug.

*Cost impacted by “Member Pays the Difference” program.

Member Pays the Difference

If you enroll in a BCBS medical plan, you will save money on retail and mail order prescriptions when you choose a generic drug over a brand name drug. This approach, called “Member Pays the Difference,” applies to the Basic HSA, Advantage HSA, and Advantage PPO medical plans.

Generic drugs are significantly less expensive than brand name drugs, yet they contain the same active ingredients and meet the same manufacturing standards. With the “Member Pays the Difference” approach, if you choose to use a brand name drug when a generic equivalent is available, you will pay the difference in cost between the brand name drug and the generic drug.

Use the “Price a Medication” tool, located on www.express-scripts.com to compare prices on generic and brand name drugs, as well as other drugs in the same class before you purchase your medications. The “Member Pays the Difference” approach can be waived if your doctor indicates that you have to take the brand name drug. You will need to contact Express Scripts to get approval to waive this approach in these situations.

An Example

Let’s look at an example of how your costs under the Advantage PPO plan could vary based on the coinsurance employee cost-sharing model:

1. The retail pharmacy cost of Lipitor, a formulary brand name drug, is $125. The cost of Atorvastatin Calcium, (the generic equivalent of Lipitor) is $40.
2. The difference in cost between the two versions is $85.
3. If you opt for the brand name drug, Lipitor, you pay $25 coinsurance, plus $85, which is the difference in the cost of the two drugs.
4. Therefore, you will pay $110 for the brand name drug

If you choose the generic drug, you only pay the generic retail copay of $10. In this example, you will save $100 by opting for the generic drug instead.

Long-Term Maintenance Medication Program

If you or a covered family member has a regular, long-term prescription for a maintenance medication, you can avoid paying the full cost for your prescription by:

• Getting a 90-day supply instead of a 30-day supply, and
• Getting your 90-day prescription filled through the Express Scripts mail order pharmacy or at a participating Walgreen-owned pharmacy

By making this switch, you can save money by getting a 90-day supply for the cost of a 60-day supply. You will pay more (100% of the cost after the second refill) if you continue to order your long-term medication as a 30-day refill or use a non-Walgreens pharmacy. More information about this program will be provided to you through the mail.

ID Cards

As a reminder, if you enroll in a Zebra BCBS medical plan for the first time or change BCBS plans at any point in the future, you will receive a new prescription drug ID card mailed to your home. You may also view your ID cards on the BCBS and Express Scripts mobile apps.