Prescription Drug Coverage

View Prescription Drug information in the 2017-18 Benefits Guide.
AFSCME Bargaining Unit members should consult the 2017-18 AFSCME Benefits Guide.

Retail and mail order prescription drug coverage is included when enrolled in a medical plan. The University prescription plan is administered by Express Scripts. Express Scripts utilizes a formulary drug listing. These lists are not all-inclusive and do not guarantee coverage. In addition to using this list, you are encouraged to ask your doctor to prescribe generic drugs whenever appropriate.

For more information on Formulary Listings visit: http://lab.express-scripts.com/about/formulary-information/. Formulary list maintained and controlled by prescription benefits management company (PBM) and is subject to changes as directed by PBM.

Elements of the Express Scripts Prescription Drug Plan include:
Advanced Utilization Management Program (Effective 7/1/17)
  • Drug Quantity Management
  • Step Therapy 
  • Prior Authorization

Exclusive Home Delivery Program
The University's prescription drug plan includes an "exclusive home delivery" program. The Exclusive Home Delivery Program pertains to maintenance medications, or prescription drugs for ongoing conditions such as diabetes or high blood pressure.

Under the Exclusive Home Delivery Program, employees can fill a prescription of a maintenance medication up to 2 times at a retail pharmacy such as CVS, Wal-Mart, or Kroger. After that, the University's health plan will cover the medication only if it is ordered through the Express Scripts Mail Order Pharmacy.

Schedule II drugs and narcotics are exempted from the exclusive home delivery program. These drugs can often be dispensed only 30 days at a time. Employees can use retail or mail order for these. There is no mail order requirement. Examples: oxycodone, ritalin, dexedrine, etc.

Other drugs with manufacturer or FDA supply limits are also exempted from the exclusive home delivery program. If a doctor is only allowed to prescribe a 30 day or other limited supply, there is no mail order requirement for that drug.

Contact Express Scripts directly at 1-866-515-1442 about specific medications.

Generics Preferred Program
The University's prescription drug plan includes a "generics preferred" program. When employees or family members need a new prescription or a refill for a brand-name drug, the pharmacist will check whether a generic drug is available instead. If a generic is available, employees are encouraged to utilize the generic option. If the employee chooses to use the brand-name instead of the generic, the employee will be charged the full cost difference between the generic and the brand-name drug. If there is no generic available, the employee will be charged the normal brand name copay.
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