Health Benefits

Your Prescription Drug Benefits

Your Prescription Drug Plan covers prescription medications that are medically necessary for the diagnosis and/or treatment of an illness or injury and must be the subject of a prescription order.

Overview

Prescription Benefits

Retail Pharmacy

Express Scripts Online Pharmacy

Specialty Medications

The Plan’s prescription medication benefits are administered by Express Scripts. You’ll save money when you choose an Express Scriptsparticipating retail pharmacy or the Express ScriptsOnline Pharmacy.

Manage your prescriptions, see your claims and much more on express-scripts.com or on the Express Scripts mobile app.

You do not pay a deductible before the Plan begins to pay benefits.

Non-Medicare Retiree Plans Annual Maximum Benefit: If you are enrolled in Retiree Plan, there is a $1,200 maximum benefit for each enrolled person per calendar year. (For Plan 2 Retirees who retired June 1, 2002 and after, the maximum benefit is $200 per enrolled person per calendar year.)

Prescription Benefits Overview

Active Employees Plan

Participating Retail Pharmacy
‍Up to a 34-day supply

Nonparticipating Retail Pharmacy
Up to a 34-day supply

Express ScriptsOnline Pharmacy
‍Up to a 90-day supply

Generic

You pay a $10 copay**

You pay 40%

You pay 20%, up to $40

Preferred brand-name

You pay 20%, up to $40**

You pay 20%, up to $80

Nonpreferred brand-name*

You pay 20%, up to $65**

You pay 20%, up to $120

Specialty medications

You pay $60**

You pay up to $60 (30-day supply maximum)

*If you choose a brand-name medication when your provider authorizes a generic substitute, you will be responsible for paying the difference between the price of the generic and brand-name medication at the time of purchase, in addition to your copay.

**When claim is submitted electronically

This is an overview of commonly used services for the Active Employees Plan. For full benefit details, please refer to the Active Employees Summary Plan Description.

Retirees Plan

Non-Medicare Retirees: Please refer to the Retiree Plans Summary Plan Description to view benefit details for your Plan.

Medicare Retirees: Please log in to your account on regence.com to see benefit details for your Plan.

Retail Pharmacy

When you fill your prescriptions at a retail pharmacy, how you pay is based on what type of pharmacy you choose:

Participating pharmacy: Simply present your ID card and pay the copay.
Non-participating pharmacy:
» You pay the full retail price.
» Then submit a claim for reimbursement for 60% of the Plan’s allowed amount.
» Payment will be sent directly to you.

To find an in-network provider, go to express-scripts.com, log in and search for a retail pharmacy near you. You can also use the Express Scripts mobile app or call (800) 372-5817.

Express Scripts Online Pharmacy

Consider using the online pharmacy for maintenance medications, which:

Are commonly used to treat conditions that are considered chronic or long-term
Usually require regular, daily use of medicines
Examples include medication to treat high blood pressure, heart disease, asthma and diabetes.

You get a 90-day supply, and pay the equivalent of two retail copays. (It’s like getting three months for the cost of two at a retail pharmacy.)

There is no charge for shipping and you can set up automatic refills.

To get started, go to express-scripts.com, log in and click “How to use home delivery.” You can also use the Express Scripts mobile app or call (800) 372-5817.

Specialty Medications

Pre-authorization is required for specialty medications. Pre-authorization helps coordinate care between prescribing physician(s), labs and other associated services. It is required for:

New specialty medication prescriptions
Changes in dose duration

Specialty prescription medications are distributed via home delivery and are limited to a 30-day supply. You’ll pay a $60 copay per prescription.

All specialty prescription medications are provided through Accredo.

Your doctor can contact Accredo for pre-authorization
To track your order, request refills, and more, go to accredo.com.

For benefit details, please refer to the Active Employees Summary Plan Description or Retiree Plans Summary Plan Description.

This website provides an overview of the Plan benefits for Active Employees and non-Medicare Retirees. Please refer to your Active Employee Plan Summary Plan Description (SPD) or Retiree Plans Summary Plan Description (SPD) for benefit details. If there is a conflict between the information provided on this website and the official Plan documents, provisions of the official Plan documents will govern how the Plans work and how the Plans pay benefits.

If you are a Medicare-eligible Retiree who is enrolled in the Trust’s fully-insured Plan through Regence, please click here to learn more about your Plan benefits.