Prescription Drug Benefits

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:

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.

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 and Kroger 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.

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 Value-Based Prescription Drug Plan (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.

• 2024 Value-Based Drug Plan Medication Guide

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.

• 2024 Specialty Medication Benefit

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 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.