Indemnity Plan Prescription Drug Benefit Questions?

Contact Express Scripts1.877.828.9744

See your plan handbook for other important details.

Step Therapy
Under this program, members are encouraged to use the most appropriate drug therapy for certain conditions.  Frequently, a physician will prescribe the most expensive drug without first trying effective, less-costly drugs proven to work for your condition. The Step Therapy program encourages the use of effective first-line drugs before expensive, second-line alternatives. Certain drugs that treat the following conditions are covered by Step Therapy: stomach acid, pain/arthritis, allergies, high blood pressure, high cholesterol, topical dermatitis, ADD/ADHD and depression.  This list is subject to change.  First-line drug treatments are safe, effective and less expensive than the second-line drugs. If your doctor thinks you need a second-line drug, he or she must contact Express Scripts to request a prior authorization.

Generics Preferred
This program provides an incentive for members to use the generic version of a brand-name drug. If your doctor writes "do not substitute" on your prescription for a non-preferred brand-name drug for which there is a generic version, you will pay the generic drug co-pay and the difference between the cost of the generic drug and the cost of the non-preferred brand-name drug. Make sure your doctor knows that not using the generic drug will cost you more. He or she may reconsider whether or not to put you on the more expensive alternative.

Express Scripts Formulary
Express Scripts sent the new 2008 formulary to all members in December 2007. For another copy, see their website.

Specialty Drugs

Specialty drugs must be filled through Express Scripts’ specialty pharmacy, CuraScript:These drugs treat complex chronic diseases, such as hemophilia, hepatitis C, HIV, multiple sclerosis, rheumatoid arthritis, infertility and cancerServices include self-injection support, education, medication adherence, counseling, refill reminders and follow-up

• Medications are delivered to your home or doctor’s office
• Co-pay for a 30-day supply is $10

Pilot Program with Value Co-Pays
Two years ago the GIC introduced pilot programs that encourage members to adhere to their cholesterol-lowering statin regimen and discourage members from taking high-cost GI/stomach drugs, such as Nexium, when other lower cost drugs might work just as well.  This pilot program, which lowers co-pays for certain generic drugs, will continue in Fiscal Year 2009. 
Members prescribed these drugs will enjoy a very low $2 retail and $4 mail-order co-pay for the following drugs:
·    Generic versions of Mevacor
·    Stomach acid medications: generic versions of H-2 antagonists, such as Tagamet 300, 400 and 800mg, Pepcid 40 mg, Axid 150 and 300mg, or Zantac 300 mg

These drugs would ordinarily have co-pays of $7 at retail and $14 through mail order.

In an effort to discourage members from taking drugs whose efficacy, value and/or safety is questionable, the following medications will stay on the non-preferred brand name drug tier of $40 retail and $90 mail-order:
·    COX-2 inhibitors: Celebrex
·    All Proton Pump Inhibitors (PPIs): e.g., Nexium, Prevacid, Aciphex, Protonix and prescription-strength Prilosec

Prilosec OTC Covered
The GIC will continue to cover over-the-counter versions of Prilosec at a co-pay cost of $7 retail and $14 mail order.  Have your physician write a prescription for Prilosec OTC to receive coverage.