Prescription Drug Benefits

Prescription medications are essential to your health – but also key drivers of medical cost – so it’s important to manage your prescription drug expenses. Prescription medication coverage is included under all medical plans. Your prescription medication costs count toward your annual deductible, after which you pay a coinsurance amount until you reach your out-of-pocket maximum.

Preventive Drugs

The deductible does not apply for preventive drug coverage. This means you do not need to meet the deductible first before your plan coinsurance kicks in for preventive drugs. The plan will pay 100% for generic drugs on the preventive medications list. If you choose preferred or non-preferred brand-name drugs from the preventive medications list, you will be required to pay the coinsurance, but not the deductible. You can find the preventive medications list as well as more information about your medications and their cost at express-scripts.com.

Mandatory Generic Drugs

The prescription drug benefit promotes the use of generic drugs to save you money. The plan will automatically substitute a generic equivalent instead of a brand-name drug when the generic is available. If you request a brand-name drug when a generic is available, you will pay the applicable deductible and coinsurance plus the difference between the generic price and the brand-name price, unless “dispense as written” appears on the prescription.

Maintenance Medications/Home Delivery

You will be able to have up to a 90-day supply of most maintenance medications delivered directly to your home through the Express Scripts Pharmacy program. Maintenance medications are those taken to treat an ongoing condition, such as high blood pressure and high cholesterol. You may also purchase a 90-day supply at a participating retail network pharmacy.

Use the PayFlex Card for Pharmacy Expenses

You may use your PayFlex Card at most retail or online locations to purchase your prescriptions and/or eligible over-the-counter items. To learn what’s eligible, access your PayFlex account through aetna.com.

  • When you enroll for the Health Care FSA for the first time, you will receive a PayFlex Card in the mail.
  • If you were enrolled last year and you already have a PayFlex Card, you should use the same card next year.