Prescription Drug Benefits - Human Resources at Ohio State
Prescription Drug Benefits
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.
Download Tools
- Health Plans Specific Plan Details
- Summary of Material Modifications issued 5/04/2023 (Benefits coverage changes related to COVID-19)
Prescription Drug Benefits Details
Hard copy prescription cards are no longer mailed by Express Scripts. With the Express Scripts mobile app, you can access your prescription card and manage your prescriptions. If you prefer a paper card, you have the option to print a card from the Express Scripts website.
First you need to register with Express Scripts, using one of these methods:
Visit express-scripts.com
Text JOIN to 69717 for a link to our registration page
Visit your device’s app store to download the Express Scripts mobile app
Note: First-time visitors must register using their member ID number or Social Security Number. When you download the Express Scripts mobile app, you can use the same username and password as your online account. After registration, you can log into the mobile app.
In addition to accessing your prescription card, here are other ways to use the app:
- Connect with pharmacists 24/7.
- Control how you hear from Express Scripts.
- Order refills, track shipments, compare prices and access plan information.
Effective Jan. 1 – Dec. 31, 2023
| PRIME CARE ADVANTAGE PRIME CARE CHOICE OUT-OF-AREA |
PRIME CARE CONNECT | |||||
|---|---|---|---|---|---|---|
| Annual Out-of-Pocket Maximum2,3 | $2,500 per person, $5,000 per family | $2,000 per person, $4,000 per family | ||||
| Deductible4 | $50 per person, $100 per family | No deductible | ||||
| Preferred Pharmacy | Non-Preferred Pharmacy | Home Delivery or Retail90 Pharmacy5 | Preferred Pharmacy | Non-Preferred Pharmacy | Home Delivery or Retail90 Pharmacy5 | |
| Supply Limitations | up to 30-day supply | up to 30-day supply | up to 90-day supply | up to 30-day supply | up to 30-day supply | up to 90-day supply |
| Generic Drug | $10 copay | $20 copay | $25 copay | $8 copay | $18 copay | $20 copay |
| Formulary Brand Name Drug | 30% coinsurance, up to $100 | 35% coinsurance, up to $110 | 30% coinsurance, up to $250 | 30% coinsurance, up to $40 | 35% coinsurance, up to $50 | 30% coinsurance, up to $100 |
| Non-Formulary Brand Name Drug | 50% coinsurance, no maximum | 55% coinsurance, no maximum | 50% coinsurance, no maximum | 50% coinsurance, no maximum | 55% coinsurance, no maximum | 50% coinsurance, no maximum |
| 1 Specific preferred insulin products will be available for a $25 copay per 34-day supply and a $75 copay per 90-day supply through the Express Scripts Patient Assurance Program only at Preferred Pharmacies. 2 The Prescription Drug Benefit annual out-of-pocket maximum is based on benefit enrollment and is separate from the medical benefit annual out-of-pocket maximum. 3 Fertility treatment has a combined medical and pharmacy $15,000 lifetime maximum and is limited to a 30-day supply per fill. Prior Authorization from OSU Health Plan is required. 4 The deductible applies to brand name medications only. 5 Retail90, also known as Smart90, is Express Scripts’ program which allows individuals to fill their prescriptions for up to a 90-day supply via select retail pharmacies. |
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Express Scripts offers prescription drug benefits through nationwide retail pharmacy locations and a home delivery mail-order service.
Retail – Express Scripts Retail Network and Retail90
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 Scripts Retail 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 Scripts Retail 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.
In addition to a 30-day supply, you may also utilize Retail90 (also known as Smart90) which allows you to fill a 90-day supply of medication at certain preferred pharmacies in the Express Advantage Network.
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 digital 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:
- Costco*
- CVS*
- Discount Drug Mart*
- Giant Eagle*
- Marc’s
- Meijer*
- OSU Outpatient Pharmacy*
- Rite Aid*
- Walmart*
*Retail90 available
To find out the status of your pharmacy or the cost of medications, please contact Express Scripts at (866) 727-5867. Please note that all Walgreens locations are excluded from the Ohio State benefit.
Home Delivery
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
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.
Formulary
The medications on the Prescription Drug Formulary Guide are chosen based on comparative clinical effectiveness, safety profiles and opportunities to help contain costs. Also see the Preferred Drug List Exclusions list.
Non-Formulary
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.
Exclusions
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.
The Ohio State University Faculty and Staff Health Plan members who 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 VBD copay for certain eligible generic drugs taken for these 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%. Only eligible members who choose to actively participate in the Care Coordination Program are 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.
Effective Jan. 1 – Dec. 31, 2023
| PRIME CARE ADVANTAGE PRIME CARE CHOICE OUT-OF-AREA |
PRIME CARE CONNECT | |||
|---|---|---|---|---|
| Preferred Pharmacy | Home Delivery or Retail90 Pharmacy4 | Preferred | Home Delivery or Retail90 Pharmacy4 | |
| Supply Limitations | up to 30-day supply | up to 90-day supply | up to 30-day supply | up to 90-day supply |
| Generic Drug | $0 | $0 | $0 | $0 |
| Formulary Brand Name Drug | 15% coinsurance, up to $50 | 15% coinsurance, up to $125 | 15% coinsurance, up to $20 | 15% coinsurance, up to $50 |
| Non-Formulary Brand Name Drug | 50% coinsurance, no maximum | 50% coinsurance, no maximum | 50% coinsurance, no maximum | 50% coinsurance, no maximum |
| 1 The Value-Based Drug Benefit eligibility is based on actively participating in the Care Coordination Program for management of specific chronic conditions (asthma, chronic obstructive pulmonary disease (COPD), diabetes, and heart disease). Visit osuhealthplan.com to learn more about the Care Coordination Program. 2 Non-Formulary Brand Name Drugs are not eligible for the Value-Based Drug Benefit. 3 The Value-Based Drug Benefit is not available at Non-Preferred Pharmacies. 4 Retail90, also known as Smart90, is Express Scripts’ program which allows individuals to fill their prescriptions for up to a 90-day supply via select retail pharmacies. |
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Specialty medications are frequently high-cost pharmaceutical products that are biotechnological in nature and available only through specialty pharmacies. The Ohio State Wexner Medical Center Outpatient Pharmacy and Accredo specialty pharmacy through Express Scripts are the only pharmacies in the exclusive specialty network. If you do not have your specialty medication filled at one of these two pharmacies, it will not be covered.
Effective Jan. 1 – Dec. 31, 2023
| Feature | Retail Delivery | OSUWMC Pharmacy and Accredo2 |
|---|---|---|
| Supply Limitations | up to 30-day supply | |
| Generic Drug | Not Available | 20% coinsurance, up to $50 |
| Formulary Brand Name Drug | Not Available | 20% coinsurance, up to $100 |
| Non-Formulary Brand Name Drug | Not Available | 50% coinsurance, no maximum |
| 1 Certain specialty medications are included in the SaveonSP copay assistance program and subject to a different copay structure. While there are copays associated with each product included in the SaveonSP program, the member copay will be $0. If an individual chooses not to enroll in SaveonSP, they will be responsible for the prescription drug copay for qualified medications, and the copay amount will not apply to the Prescription Drug Benefit out-of-pocket maximum. 2 In certain cases, the outpatient pharmacy at Nationwide Children’s Hospital may also fill prescriptions under the Specialty Medication Benefit. Contact OSU Health Plan for details. |
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For greater details about the Prescription Drug Benefit, refer to the 2023 Faculty and Staff Health Plan Specific Plan Details (SPD) Document. If the information in this summary differs from the Specific Plan Details document, the Specific Plan Details document will govern.
Express Scripts has partnered with SaveonSP to offer a prescription copay assistance program for members taking certain specialty medications. The SaveonSP program takes advantage of available pharmaceutical manufacturer assistance dollars which helps to reduce the cost of the medication for members and the plan. By changing the plan design to increase the member’s cost share for select specialty medications, the copay assistance available from the manufacturers of those medications can be maximized, which will result in the medication becoming available to you with zero ($0) out-of-pocket cost.
This program is available through each of the existing pharmacies in the exclusive specialty pharmacy network for Ohio State’s plan: Accredo, OSU Outpatient Pharmacy, and Nationwide Children’s Hospital. Members who take a medication on the SaveonSp List are eligible to participate and begin enjoying savings in 2020 once they enroll in the SaveonSP program by calling SaveonSP at 1-800-683-1074.
Enrollment is voluntary, however, if you choose not to participate in the SaveonSP program, you will be responsible for the entire increased copay amount for the SaveonSP specialty medications you fill. It is also important to note that these copay amounts do not apply toward your annual deductible or out-of-pocket maximum.
The Patient Assurance Program offers savings to members who use insulin products to manage their diabetes. It provides a 30-day supply of certain insulin medications for no more than $25 or a 90-day supply for no more than $75 when obtained at preferred pharmacies.
If using a preferred pharmacy and with a prescription, the medications on the preventive list are covered with no out of pocket cost to the member if eligibility criteria are met.
| Drug Category | Eligibility Criteria | |
|---|---|---|
| Aspirin for cardiovascular disease | Men age 45 to 79 years AND Women age 55 to 79 years |
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| Aspirin for preeclampsia | Women of child-bearing years, who are at increased risk of preeclampsia after 12 weeks gestation | |
| Oral fluoride supplementation | Children from birth through 16 years old | |
| Iron supplementation in children | Children from birth to 12 months of age | |
| Folic acid supplementation | All women planning or capable of pregnancy | |
| Breast cancer prevention | Subject to Prior Authorization:
|
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| Vaccines | See Preventive Health Care Guidelines available online at osuhealthplan.com under Forms and Downloads |
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| HIV Pre-Exposure Prophylaxis | Emtricitabine/Tenofovir Disoproxil Fumarate (generic) | |
| Bowel Preparations | Certain bowel preparation agents for screening colonoscopy for men and women ages 50 to 75 years | |
| Statin drugs for the primary prevention of cardiovascular disease | Low- to moderate-dose statins for men and women age 40-75 years. These medications include:
|
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| Drug/Device Category | Eligibility Criteria | |
|---|---|---|
| At least one form of women’s contraception in each of the 18 “methods” of contraception outlined in the FDA birth control guide. See Preventive Health Care Guidelines available online at osuhealthplan.com under Forms and Downloads. | Women only. No age restriction. | |
| Drug Category | Eligibility Criteria | |
|---|---|---|
| Prescription and Over-the-Counter products with a physician prescription. | Men and women age 18 and older. | |
If you are a pet parent, you know nothing can replace the love of our furry family members. However, just like humans, health care costs for pets can be expensive. Especially if you are dealing with expenses for prescriptions treating chronic conditions such as diabetes, anxiety, arthritis, or heart disease, it can be a real burden to your budget.
But help is on the way – Ohio State, through our partnership with Express Scripts, will provide savings opportunities for Ohio State employees when purchasing certain prescriptions for pets. Inside Rx Pets is a program offering for certain human medications that are also prescribed for veterinary use and available through a network of participating pharmacies. On average, it provides a savings of 75% on generic medications and 15% on brand medications for pet owners purchasing these medications for their pets.
Visit the Inside Rx Pets website to learn how to get started.
You may experience difficulty with colors on the Express Scripts website and mobile app. While we work with Express Scripts to try and improve this accessibility concern, you may contact HR Connection at 614-247-6947 Monday – Friday 8 a.m. to 5 p.m. ET for assistance.
This is intended to be an overview. Refer to the Plan Document for complete information. In the event the information on these pages differs from the Plan Document, the Plan Document will govern.
