Prescription Drug Program - Human Resources at Ohio State
Prescription Drug Program
The health and well-being of faculty and staff is a priority at Ohio State. All of the benefits available to you reflect Ohio State’s commitment to providing high-quality, affordable medical plans and represent a significant component of your total rewards. Access to prescription drugs is a vital part of our medical coverage.
All of the university’s medical plans include prescription drug benefits through Express Scripts, available via home delivery mail-order service and nationwide retail pharmacy locations. You choose which option is most convenient for you and your family.
Prescription Drug Program Details
Express Scripts offers prescription drug benefits through nationwide retail pharmacy locations and a home delivery mail-order service.
Retail – Express Advantage Network
You may use your retail benefit for prescription medications required on a short-term basis, such as antibiotics, or for a 30-day supply of medications used on a continuing basis. The Express Advantage Network allows members to take advantage of higher savings at a preferred retail network pharmacy. You may still use retail pharmacies that do not participate in the Express Advantage Network, but your out-of-pocket costs will be higher if you use a non-preferred retail pharmacy. If you utilize an excluded pharmacy (not listed as preferred or non-preferred), you will be responsible for paying the full cost of any medication. To locate a network pharmacy, use the Locate a Retail Pharmacy tool offered by Express Scripts. When you have a prescription filled at a network pharmacy, present your medical/Rx card to the pharmacist, who will use an automated system to verify your coverage and prescription cost.
Examples of pharmacies in the preferred retail network include, but are not limited to:
- Giant Eagle
- Discount Drug Mart
- Rite Aid
- Sam’s Club
To find out the status of your pharmacy or the cost of medications, please contact Express Scripts at (866) 727-5867.
Express Scripts’ home delivery service provides a convenient and cost-effective way to order a 90-day supply of medicine you take on a continuing basis. Through this program, you can get many of the same maintenance medications that you have filled at a retail pharmacy delivered right to your mailbox. Home Delivery can be used for a new maintenance prescription or refills. Register on the Express Scripts website.
Generic drugs must meet the same FDA standards of composition, safety, strength, purity and quality as brand-name drugs. If you receive a generic drug, you will pay a lower amount than for a brand-name drug. The next time you receive a prescription, ask your doctor or pharmacist if a generic alternative is available and appropriate for you.
The medications on the Prescription Drug Formulary Guide are chosen based on comparative clinical effectiveness, safety profiles and opportunities to help contain costs.
Brand-name medications that are not part of the formulary list are commonly considered non-formulary. Non-formulary brand-name drugs are typically those that have a generic equivalent, are higher cost or are newly released to the market. When a new drug comes onto the market, the Express Scripts Pharmacy and Therapeutics Committee evaluates the drug’s safety and efficacy compared to similar drugs already available.
Specialty medications are usually high-cost pharmaceutical products that are generally, but not exclusively, biotechnological in nature.
Certain medications are excluded from the prescription drug plan and not covered. The Faculty and Staff Health Plans Specific Plan Details document has a list of excluded prescription drugs.
Prior authorization is required for some medications. Once approved, the authorization is valid for up to one year. If a prescription drug requiring prior authorization is not approved for coverage under the plan, you will be responsible for paying the full cost of the medication. (see List of Medications Requiring Prior Authorization)
Faculty, staff and their dependents who are participating in Prime Care Advantage, Prime Care Choice, Out of-Area or Prime Care Connect and are actively participating in the Care Coordination Program for management of asthma, chronic obstructive pulmonary disease (COPD), diabetes and/or heart disease (coronary artery disease or congestive heart failure) are eligible for the VBD. The copay for certain eligible generic drugs taken for the chronic condition(s) will be waived and the member cost-share for certain eligible formulary brand- name drugs taken for the chronic condition(s) will be reduced by 50 percent for eligible participants. If you choose not to actively participate in the Care Coordination Program or are enrolled in the Basic medical plan, you are not eligible for the VBD. Eligible VBD medications obtained at a non-preferred pharmacy will not receive the VBD discount and will be subject to the applicable benefit copay/coinsurance. (see the Value-Based Prescription Drug Plan Design Benefit Guide)
Prescription Drug Program FAQ
Prescription drug coverage is included in all Ohio State medical plans. See rates for medical coverage.
No. Your medical ID card serves as your prescription card.
The Prescription Drug Plan, VBD and Specialty Plans have a combined deductible and annual out-of-pocket maximum. Refer to the Prescription Drug Plan Summary Chart.