Prescription & Pharmacy Coverage

Your prescription drug plan through Express Scripts offers low co-pays for generic medication, home delivery service for maintenance medications, and a specialty pharmacy for some long term health conditions that require special medicines.

Have Eligible Out-of-Pocket Expenses?

Generic Medications

Generic Medications

30 Day Supply

$5.00 Co-Pay

90 Day Supply

$10.00 Co-Pay

NO Co-pay for Generic Medication when filled at Rite Aid Pharmacies
Preferred Brand Medications

30 Day Supply

25% of cost of medication

  • or no more than $75.00 Maximum Co-Pay

90 Day Supply

25% of cost of medication

  • or no more than $150.00 Maximum Co-Pay
Non-Preferred Brand Medications

40% of total cost of medication

  • No Maximum Co-Pay
Prescription Out-of-Pocket Maximums

Individual OOP Max

$4,800 per plan year

Family OOP Max

$9,600 per plan year

Please note: once an individual or family has reached their OOP Max, the Fund will pay 100% for all further eligible claims for the duration of the Plan Year.

Prescribed a high cost specialty medication?

If so, contact Diplomat Specialty Pharmacy.

Prescription & Pharmacy FAQs

What is the Prescription Benefit?

Prescriptions are paid by using your Express Scripts/Medco card.

Do I still have to use Mail Order?

Yes, once you have the same script filled three (3) times for a Maintenance Drug, you must utilize the Mail Order Service with Express Scripts for the duration of your use of the medication.

What's the difference between a Non-Preferred & Preferred Brand Medication?

Non-Preferred Brand Medications typically offer a generic substitute to safely and effectively treat medical conditions. If you are prescribed a Non-Preferred Brand Medication, you will be responsible for 40% of the total cost of the medication. By asking for generic substitutes wherever possible, you maximize your savings. Only you and your prescribing Physician can determine if a generic substitute is right for you. If you're unable to take a generic substitute for your Non-Preferred Medication, ask your Prescribing Physician for samples, or manufacturer's coupons when possible.

Preferred Brand Medications ordinarily do not offer a generic substitute. For Preferred Brand Medications, you will never pay more than $75.00 out-of-pocket for a 30-day supply, or $150.00 for a 90-day supply. Click the following link for the Express Scripts Preferred Drug List to see if your Medication is considered a Preferred Brand. You may also visit Express Scripts online at www.express-scripts.com for a comprehensive list.

My Prescription ID Card says 'Medco' on it. Will I get a new card?

Your current Prescription ID Card has the same ID number as any new, or duplicate ID card. Even though your existing Prescription ID card may still have the 'Medco' logo on it, your client information remains unchanged. There is no need for new Prescription ID Cards, just keep using the one you already have.

What do I do if I lose my Prescription card?

You can call the Fund Office at 215-568-0430 and we will request a new Express Scripts card for you, or call Express Scripts at 1-800-939-2146 or visit their website at www.express-scripts.com

Is there an Out-of-Pocket Max for prescriptions?

Yes, for Plan Year May 1, 2019 through April 30, 2020, the prescription out-of-pocket maximum is:

  • $4,800 Individual, or
  • $9,600 Family

Once an individual or family has reached their OOP Max, the Fund will pay 100% for all further eligible claims for the duration of the Plan Year.