IQVIA Benefits Handbook
AT A GLANCE
What's Covered
The program covers in-network retail and mail order pharmacy generic, brand name and specialty drugs. No coverage is provided for prescriptions filled at a non-network pharmacy.
Retail Pharmacy Network
The Express Scripts network includes over 68,000 pharmacies nationwide. To locate a pharmacy, visit www.express-scripts.com or call 866-790-8276. For Kaiser pharmacies, call 800-464-4000. No coverage is provided for prescriptions filled at a non-network pharmacy.
Mail Order Pharmacy
Mail order allows you to order up to a 90-day supply of prescription medication and have it delivered to your home. You can order online at www.express-scripts.com, by phone at 866-790-8276 or Kaiser online at https://healthy.kaiserpermanente.org/, by phone at 800-464-4000 or through the mail.
With Express Scripts, you can also fill a 90-day supply of maintenance medication at a CVS network pharmacy using the CVS Smart90 Program.
The table below highlights the key differences between retail and mail order:
Question
Retail Pharmacy
Mail Order Pharmacy
When should I use retail vs. mail order?
Short-term, immediate medication needs
Long-term, ongoing medication needs
How much can my doctor prescribe?
Up to 30-day supply plus refills
Up to 90-day supply* plus refills
Do I have to file claims?
No (unless you don't have your ID card – you can call Express Scripts or Kaiser to get your plan information and share it with the pharmacy)
No
*100-day supply with Kaiser.
The table below shows your cost per prescription under each medical plan option:
 
$400 Deductible PPO Plan
$900 Deductible PPO Plan
$1,850 Deductible Plan with HSA
$2,850 Deductible Plan with HSA
Retail Pharmacy—30-day Supply
Generic
$10 copay
$10 copay
20% after the medical plan deductible*
30% after the medical plan deductible*
Brand Formulary
$30 copay
30% (min. $25/max. $50)
20% after the medical plan deductible*
30% after the medical plan deductible*
Brand Non-Formulary
$60 copay
45% (min. $40/max. $80)
20% after the medical plan deductible*
30% after the medical plan deductible*
Mail Order – 90-day Supply*
Generic
$25 copay
$25 copay
20% after the medical plan deductible**
30% after the medical plan deductible**
Brand Formulary
$75 copay
30% (min. $62.50/max. $125)
20% after the medical plan deductible**
30% after the medical plan deductible**
Brand Non-Formulary
$150 copay
45% (min. $100/max. $200)
20% after the medical plan deductible**
30% after the medical plan deductible**
* 100-day supply with Kaiser.
** Except for preventive maintenance medications. If you enroll in the $1,850 or $2,850 Deductible Plan, preventive maintenance medications for asthma, diabetes, high cholesterol and high blood pressure are covered 100% before the deductible. Visit the Express Scripts website or contact Kaiser for a list of covered preventive medications.
You pay no copays/coinsurance for smoking deterrents.