If you elect medical coverage, you automatically receive prescription drug benefits through Express Scripts. The amount you pay for your prescriptions depends on whether you:
- Have met the applicable deductible
- Choose generic, brand-name formulary or brand-name non-formulary drugs
- Purchase your prescription at a participating pharmacy or through the mail-order service
Review the table below for a high-level view of how prescription costs compare based on your medical plan election.
| Aetna Choice POS II CDHP with HSA | Aetna Choice POS II (PPO) | |||
|---|---|---|---|---|
|
Express Scripts Participating Pharmacy |
Non-participating Pharmacy |
Express Scripts Participating Pharmacy |
Non-participating Pharmacy |
|
|
Annual deductible |
$1,800/employee only coverage $3,600/all other coverage levels All retail and mail-order pharmacy expenses are subject to the combined medical and prescription drug annual deductible1 |
$3,600/employee only coverage $7,200/all other coverage levels All retail and mail-order pharmacy expenses are subject to the combined medical and prescription drug annual deductible |
$50/individual $100 maximum per family (Applies to retail only) |
|
|
Annual out-of-pocket maximum |
$4,000/employee only $8,000/all other coverage levels All retail and mail-order pharmacy expenses are subject to the combined medical and prescription drug annual out-of-pocket maximum |
$8,000/employee only $16,000/all other coverage levels All retail and mail-order pharmacy expenses are subject to the combined medical and prescription drug annual out-of-pocket maximum |
$2,000/individual $4,000/family Applies to retail and mail-order prescription drugs only (Separate from medical out-of-pocket maximum) |
|
|
Retail through participating pharmacy |
|
You must meet the deductible before the plan begins to pay benefits. You pay 100% of the retail cost and submit a claim for reimbursement. The plan will reimburse you for the participating pharmacy cost of the prescription drug less the member coinsurance. Note that any amounts in excess of the participating pharmacy will not be reimbursed. |
You must meet the deductible before you pay coinsurance for eligible expenses:
|
You must meet the deductible before the plan begins to pay benefits. You pay 100% of the retail cost and submit a claim for reimbursement. The plan will reimburse you for the participating pharmacy cost of the prescription drug less the member coinsurance. Note that any amounts in excess of the participating pharmacy cost will not be reimbursed. |
|
Mail-order |
|
Not available |
|
Not available |
1 Through the CDHP, preventive drugs such as vitamins, vaccines, weight loss agents, fluoride preparations, and cholesterol-lowering drugs that are prescribed by your medical care provider are covered at 100%, before the annual deductible. For a complete list, visit Arkema Benefits Online, then click on Forms > Health Forms > Prescription > CDHP Preventive Drug List.
2 If a generic drug is available and you purchase a brand-name (formulary or non-formulary) drug, you will pay the applicable retail coinsurance or mail-order copay, plus the difference in the cost between the brand-name and generic drug.
3 You must meet the combined medical and prescription deductible before the plan begins to pay benefits.
Accessing Your ID Card
You should have received a new ID card if you enrolled in Medical coverage for the first time or made any changes to your medical plan elections for this year. If you haven’t made any changes to your medical plan or coverage, you can continue to use your existing card. If you want to request a new ID card, you can log onto Express-Scripts.com (or you can register if new to the site) and request one or you speak to a member services representative at 1-800-363-8952. If you use the same local pharmacy, you usually don’t have to provide an ID card once you are in their system.
Prescription Drugs and the CDHP Plan
You must pay the full price of prescription drugs until you meet your deductible. If you use an in-network participating pharmacy, prescription drug costs are counted toward the combined medical and prescription drug deductible. If you do not use a participating pharmacy, you must first meet the out-of-network combined deductible before the plan begins to pay benefits. The plan will pay 100% of eligible expenses for the rest of the year when you meet the combined out-of-pocket maximum.
Certain preventive drugs are not subject a deductible and no copay is charged. See the Preventive Drug List for more information.
Prescription Drugs and the PPO Plan
You will pay the full price of drugs until you meet the annual retail-only prescription drug deductible of $50 per individual or $100 per family. After you meet the deductible, you pay coinsurance until you reach the prescription drug out-of-pocket maximum. You pay copays for your mail-order prescriptions, with no deductible, until you reach the prescription drug out-of-pocket maximum.
If you do not use a participating pharmacy, you will pay the full cost of the prescription and file a claim for reimbursement. You will be reimbursed at the price that would have been charged at the participating pharmacy, less your applicable copay. The plan will pay 100% of eligible retail and mail-order prescription drug expenses for the rest of the year when you meet the prescription drug out-of-pocket maximum.
Arkema offers you a range of tips and programs to save money on your prescription drugs.
Generic Drugs
Using generic drugs can save you money. Your prescriptions will be filled with a generic drug, unless your provider specifically requests a brand-name drug and writes “dispense as written” on your prescription. If a generic drug is available and you purchase a brand-name (formulary or non-formulary) drug, you will pay the applicable retail coinsurance or mail-order copay, plus the difference in cost between the brand-name and generic drug.
Mail-Order Service (Required For Maintenance Medications)
The cost of mail-order service is often less than you would pay for a 90-day supply at a retail pharmacy. If you take maintenance medications for conditions such as high blood pressure, high cholesterol or asthma, you will be required to have them filled by the mail-order service. Visit www.express-scripts.com or call 1-800-363-8952 to start receiving your medications through mail-order.
Rx Savings Solutions
You and your family members enrolled in an Arkema medical plan will have access to Rx Savings Solutions, a program that can identify cost savings opportunities for prescriptions. This program is available at no cost to you. To find out more and register for the program, visit rxsavingssolutions.com/solutions/members or call 1-800-268-4476.
SaveonSP for those enrolled in the Aetna PPO Plan
If you’re enrolled in the Aetna PPO plan, you can use SaveonSP, a program that can help you save money on certain specialty medications for complex conditions like multiple sclerosis, cancer and rheumatoid arthritis. If your specialty medication is on the SaveonSP drug list, you must participate in the SaveonSP program and the drug manufacturer’s assistance program to receive your medications at no cost. If you opt out of the SaveonSP program, you will be responsible for paying the full price for the prescription medication and the costs will not count towards your deductible or out-of-pocket maximum. If eligible, SaveonSP will reach out to you to gather information upon filling your first prescription through Accredo, Express Scripts’ specialty mail pharmacy.
Accredo Specialty Pharmacy
If you take specialty medications, you can fill your prescriptions through ESI’s Accredo Specialty Pharmacy. Accredo pharmacists are available to answer questions 24/7, and their care team will follow up with you after you receive your medication to ensure you receive the clinical care and support you need. Call Accredo at 877-222-7336 for more information.