Benefit Summary: Prescriptions


Drug Card Program

This program is administered by Express Scripts (ESI) who will issue you an ID card when you become eligible. You will be issued additional Express Scripts prescription benefit ID cards to use to have your prescription claims processed automatically. Most pharmacies participate in the program, which provides you and the Plan with discounted prices on most drugs.

You should only use your Drug Card for short-term prescriptions such as antibiotics—your out-of-pocket costs will be lower if you use the Mail Service Program for your long-term prescription drug needs.



Drug Card Benefits

When you use your Express Scripts ID Card at a participating pharmacy, you will pay 100% of the medication's cost before you meet your deductible. After the calendar year Comprehensive Medical Benefit deductible is satisfied, you will pay a 20% coinsurance for covered medications. If you select a brand drug when your physician allows a generic, you will have to pay the difference. If you don't use the card or if you go to a nonparticipating pharmacy, you'll pay 100% of the cost and must mail in a claim form to Express Scripts for reimbursement.




Mail Service Program

This program provides long-term or maintenance prescription drugs to Plan participants at discounted prices.

The Plan's regular deductible and payment provisions don't apply to prescriptions filled by the mail-service pharmacy. Instead, you pay the following co-pays to Express Scripts each time you order up to a 90-day supply of your medication:

For a 90 day supply of:
Your Copay
Generic drugs $10
Preferred brand name drugs (when generic not available) $20
Non-preferred brand name drugs $35

Specialty Drugs

There is also a mandatory mail order program for specialized medications such as high-cost injectable, infusion, intravenous, and certain oral medications. The specialty drug mail order program is administered by CuraScript™ (a subsidiary of ESI). These drugs are prescribed for diseases such as multiple sclerosis, rheumatoid arthritis, etc.; they often require special handling and are very expensive, and they are not usually stocked in retail pharmacies. Patients MUST go through CuraScript for all specialty drugs, regardless of where the drug will be administered (this includes drugs that will be administered in a doctor's office). Specialty drugs that are not procured through CuraScript will not be covered under the Lineco medical plan. Copays for specialized medications are the same as for the mail service program.



Specialty Step Management Program

"Step therapy" is used to guide a patient with a chronic condition to a less costly medication (called a "step one" drug), if appropriate, before he tries a more expensive drug (called a "step two" drug). The goal is to ensure that the patient receives an appropriate medication for his condition. Since an appropriate drug is not always the most costly, step therapy can also help reduce costs.

This program affects four categories of specialty drugs:

Erythroid stimulants Epogen, Arenesp
Growth hormones Genotropin, Humatrope, Nutropin/AQ, Tev-Tropin, Norditropin/Norfles, Omnitrope, Saizen
Multiple sclerosis Extavia, Avonex
Inflammatory conditions Simponi, Cimzia, Kineret, Amevive, Stelara, Rituxan, Remicade, Orencia, Actemra
Only patients who are newly prescribed medications in these categories will be affected.

Express Scripts will mail affected participants more information about the Specialty Step Management Program.

Please note that Lineco requires many specialty drugs to be ordered through CuraScript, the Express Scripts specialty pharmacy.


Prescriptions under Medicare

If you are Medicare-eligible, you will pay a 20% co-pay for your covered prescriptions at retail pharmacies, instead of paying full price and filing a claim for reimbursement. If your 20% co-pays from retail and mail service combined reach $1,000 during a calendar year, you will pay $0 for prescription drug co-pays during the rest of that year. You must use participating pharmacies--no benefit will be provided for out-of-network pharmacy purchases. Also, use of the mail-service pharmacy is mandatory after the original supply plus one refill of any prescription.


Additional Information

Express Scripts
Customer Service: 1-(877)-327-0568
Website: www.express-scripts.com