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Express Scripts Prescription Benefit Manager

On this page: Retail Pharmacies | Cost | Refills and New Rx Orders | Specialty Medications | Things You Can Do

Forms & Publications

Express Scripts manages IU's prescription drug benefit. This benefit covers most prescription drugs, plus insulin and some over-the-counter (OTC) diabetes supplies and certain other OTC items considered preventive.

Retail Pharmacies

Express Scripts pharmacy network includes most retail chain pharmacies, such as CVS, Walmart, Target, and most supermarket pharmacy chains. Some independent pharmacies are included also.

Co-pays and costs

Anthem HDHP and PPO $500 Plans Co-pays

Anthem PPO HDHP Rx Copays:

Retail (up to 30-day supply)
In-Network: 20% after deductible
Out-of-Network: 40% after deductible

Mail Order (up to 90-day supply) and Specialty
In-Network: 20% after deductible
Out-of-Network: Not covered

Anthem PPO $500 Deductible Rx Copays:

Retail (up to 30-day supply)
In-Network:
Tier 1 - $8 (For brand with generic, member pays generic copayment and cost difference between brand and generic.)
Tier - 2 $25
Tier 3 - $45
Non-Covered Drugs (with Network Discount) – Member pays 100%

Out-of-Network: 50% coinsurance plus amounts above the network’s discounted price

Mail Order (up to 90-day supply) and Specialty
In-Network:
Tier 1 - $20 (For brand with generic, member pays generic copayment and cost difference between brand and generic.)
Tier 2 - $62
Tier 3 - $112
Non-Covered Drugs (with Network Discount) – Member pays 100%

Out-of-Network: Not covered

IU Health Plan Co-pays

Retail Pharmacy Prescription Drugs (up to 30-day supply)

  • In-Network: member pays 20% after deductible (no deductible on Preventive Rx)
  • Out-of-Network: no coverage

Mail Service Pharmacy Prescription Drugs (up to 90-day supply) and Specialty Drugs

  • In-Network: member pays 20% after deductible (no deductible on Preventive Rx)
  • Out-of-Network: no coverage
Graduate Appointees/Appointed PostDoc Fellows Plan Co-pays

Retail Pharmacy Prescription Drugs (up to 30-day supply)

  • $8 generic
  • $25 preferred brands
  • $45 non-preferred brands

Mail Service Pharmacy Prescription Drugs (up to 90-day supply)

  • $20 generic
  • $62 preferred brands
  • $112 non-preferred brand
IU Residents Plan Co-pays

Retail Pharmacy Prescription Drugs (up to 30-day supply)

  • $10 generic
  • $25 preferred brands
  • $75 non-preferred brands

Mail Service Pharmacy Prescription Drugs (up to 90-day supply)

  • $25 generic
  • $60 preferred brands
  • $180 non-preferred brand

For additional information about copays and coinsurance costs for prescriptions and/or to find network pharmacies, visit the Express Scripts web site.

Tobacco Cessation Prescription Benefits
IU employee medical plans cover 100 percent of the cost of tobacco cessation prescription and over-the-counter tobacco replacement products. Coverage is limited to a 180-day supply per covered individual per year. Covered prescriptions drugs include Chantix, Zyban (bupropion), and Nicotrol. Over-the-counter products require a prescription in order to be covered under the employee's medical plan.

Refills and New Prescription Orders

Mail order refills and new prescriptions can be requested online, by telephone, or through the U.S. mail with Express Scripts.

Specialty Medications

Express Scripts has a separate arrangement for specialty medications through Accredo. (Specialty medications are drugs that are used to treat complex conditions, such as cancer, growth hormone deficiency, hemophilia, hepatitis C, immune deficiency, multiple sclerosis, and rheumatoid arthritis.)

Things you can do…

 

Contact

Express Scripts Member Services
800-988-1794

Express Scripts on the Web

Forms

Claim Form (PDF)

Mail Order Form (PDF)

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