Understanding your prescription drug benefits
All medical plan options include prescription drug benefits through Express Scripts, available at any participating pharmacy and through mail order.
Plus Plan (Kelsey, Memorial Hermann, and Texas Medical Neighborhood) and Basic Plans (Kelsey, Memorial Hermann, and Texas Medical Neighborhood)
- You pay an annual deductible of $50 before the plan begins to pay its share of your prescription drug costs.
- It is important to note that this is a separate deductible from the medical plan deductible.
- Once you have met your deductible, you pay a copay for your prescriptions.
- The money you pay out of your pocket for drugs, either in copays or in meeting your deductible, is applied towards meeting your medical plan’s coinsurance maximum except for specialty drugs copays which are eligible for the SaveonSP Manufacturer Copay Assistance Program.
- When your out of pocket maximum is met, your prescription drugs will be covered at no cost to you for the remainder of the calendar year.
No-cost prescriptions for high blood pressure, high cholesterol, and diabetes
Generic drugs for high blood pressure, high cholesterol or diabetes (including injectable insulin) remain available at no cost to you, as long as you’re enrolled in an HISD medical plan and purchase 90-day supplies through Express Scripts or at an Express Scripts Smart90 retail pharmacy partner. HISD plans also cover women’s generic contraceptives (as well as those that have no generic available) at 100%.
Express Scripts Smart90 Program
Express Scripts, HISD’s pharmacy benefits management company, offers you a list of participating pharmacies. If you need a short-term prescription like an antibiotic or pain medication, take the prescription and your Express Scripts member ID card to any of these participating pharmacies.
For long-term and maintenance medications, the Smart90 Program allows you to receive a 90-day supply of your medication in two ways, either through the Express Scripts Mail Service Pharmacy (online, by phone or through mail) or at a Smart90 retail pharmacy near you. No matter which option you choose, your copay remains the same. You must obtain a 90-day prescription from your physician. 90-day maintenance prescriptions can be picked up locally at Costco, HEB, Kroger, Randall's, Kelsey Seybold, and Walmart or through mail order. Refer to www.express-scripts.com or call Express Scripts at 855-712-0331 for the most current network information.
For new long-term drug prescriptions, you can get two 30-day supplies of your medication at any network retail pharmacy for the retail copay, but after that, you will need to use the Smart 90 Program described above or you will have to pay the mail copay to receive a 30-day supply at any network retail pharmacy. Ordering a 90-day supply through Express Scripts Mail Service Pharmacy or a Smart90 retail pharmacy (retail location or mail order) will result in substantial savings to you for long-term and maintenance medications.
You can also use one of several retail pharmacies to fill a 90 day supply of maintenance medications, including Costco, HEB, Kroger, Randall's, Kelsey Seybold, and Walmart.
Using mail order pharmacies
Mail order pharmacies are a cost-effective and convenient choice for any medications you will take for a long time, including those maintenance medications provided at no charge.
To take advantage of the benefits of mail order:
1- Go to Express Scripts or the HISD website Forms page to download the form.
2- Complete the prescription drug order form and mail to the address indicated.
3- Once your prescriptions are ordered, you can sign up for the Express Scripts automatic refill program. Express Scripts will even request a new prescription from your doctor when your refills are up or your prescription has expired.
Getting specialty drugs
When you have chronic or difficult medical conditions, such as multiple sclerosis or rheumatoid arthritis, your doctor may prescribe specialty drugs. These drugs typically require special handling, administration or monitoring. Should you require a specialty drug, use Express Scripts specialty mail order pharmacy, Accredo.
Some drugs require prior authorization, step therapy, and/or quantity limits before your plan pays for the drug. The list of drugs requiring prior authorization, step therapy or quantity limitations can be found at the link Express Scripts. You can also find information on alternative drugs that do not require prior authorization on the site.
Express Scripts discount program
Employees who waive HISD-sponsored medical coverage may enroll in the Express Scripts Discount Rx program. Eligible employees can enroll in this benefit by (1) signing up via the HISD portal or (2) calling the HISD Benefits Service Center from 7 a.m. - 7 p.m., Monday through Friday at 877-780-HISD (4473). Eligible employees can do this at initial eligibility, annual enrollment or during a qualifying life event change. The program entitles you to a cash discount through Express Scripts participating pharmacies and mail service. The Discount Rx card is not insurance, and you do not have a copay amount. You are responsible for paying 100% of the discounted Express Scripts price and any dispensing fee. It is simply a discount program. Express Scripts will provide you an ID card when you choose to enroll.
Express-Scripts' SaveonSP (Specialty Pharmacy) Manufacturer Copay Assistance Program
Express-Scripts' SaveonSP Manufacturer Copay Assistance Program is designed to help you save money on certain specialty medications. If you participate in this program, certain specialty medications will be free of charge ($0). Your prescriptions will still be filled through Accredo, your existing specialty mail pharmacy. If you are currently taking or will be taking a specialty medication, Express-Scripts will contact you if are eligible to participate in the SaveonSP program. Enrollment in the program is voluntary. If you choose not to participate, you will be responsible for the copay. Keep in mind that the copay will not count towards your deductible or out-of-pocket maximums.
For more information regarding the SaveonSP Manufacturer Copay Assistance Program, please contact SaveonSP at 1-800-683-1074 Monday - Thursday 8:00 a.m. - 8:00 p.m. Eastern and Friday 8:00 a.m. - 6:00 p.m. Eastern.
For more information about prescription drug coverage, call Express Scripts customer service at 855-712-0331 or log on to the Express Scripts website. You can order home delivery online, by phone or by completing a home delivery form (available online) and mailing to the address on the form.