IQVIA Benefits Handbook
HOW THE PRESCRIPTION DRUG PROGRAM WORKS
Each time you need a prescription filled, you can:
The following provisions apply:
- Each family will be issued two ID cards. You can also download the Express Scripts app to your mobile device, where you can view an electronic ID card. In the Kaiser plans, each covered member will receive an ID card which will serve as a combined medical and prescription card.
- In the $400 Deductible PPO Plan, you have a copay for generic, brand formulary, brand non-formulary and specialty drugs.
- In the $900 Deductible PPO Plan, you have a copay for generic drugs, and coinsurance for brand formulary, brand non-formulary and specialty drugs.
- In the $400 Deductible PPO Plan and $900 Deductible PPO Plans, prescription drug costs do not count toward the medical plan deductible.
- In the $1,850 Deductible with HSA Plan and $2,850 Deductible with HSA Plan, you pay coinsurance for generic, brand formulary, brand non-formulary and specialty drugs after your deductible, except for preventive medications which are covered at 100%.
- In the $1,850 Deductible with HSA Plan and $2,850 Deductible with HSA Plan, prescription drug costs do count toward the combined medical and prescription drug deductible. You pay the full cost of prescription drugs until you meet the combined deductible, then you pay coinsurance (except for preventive medications).
- Certain chronic and/or genetic conditions require special pharmacy products and can only be dispensed through Express Scripts Exclusive Specialty pharmacy, Accredo. With Express Scripts, you are required to use the mail order specialty pharmacy after the first two fills of a specialty medication at a retail pharmacy. Specialty medications are dispensed through Kaiser's pharmacy.
- Only medically necessary drugs prescribed by a licensed physician are covered.
Federal law requires both generic and brand name drugs to meet the same standards of strength, dosage, safety and effectiveness. Generic drugs typically cost less than brand name drugs and are generally considered to be equally effective.
- Brand Name Drugs: Drugs that are manufactured and marketed under a product name by a pharmaceutical company. Typically, the company holds a patent on the drug's chemical components for a specified period of time. Express Scripts and Kaiser split the "brand" drug tier into brand formulary and non-brand formulary drugs. Non-brand formulary drugs will cost you more out-of-pocket because they are more expensive to provide. You can still choose the medications that are right for you, but you will realize the biggest savings by choosing a brand formulary drug over a non-brand formulary drug.
- Generic Drugs: FDA-approved generic drugs have been tested for quality and strength, and can be expected to work as well as brand name drugs. They provide the same health benefits as their brand name versions, but at a lower cost to you.