Prescription Drug Program

This program covers most of the commonly prescribed medications approved by the Food and Drug Administration (FDA).

Exclusions:

• over the counter medications,
• vitamins other than prenatal medications requiring a prescription,
• topical acne medications,
• weight loss medications,
• blood and blood products,
• cosmetic products, and
• experimental or investigational medications.

Prescription Tiers

•  Generic Drugs are identical, or bioequivalent to a brand name drug in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use. Although generic drugs are chemically identical to their branded counterparts, they are typically sold at substantial discounts compared to the price of a brand name drug.

•  Preferred Brand Name Drugs

•  Non-Preferred Brand Name Drugs are high expense drugs, often the newer or highly advertised medications. Many of the drugs have a brand or generic equivalent.

Pharmacy Benefit Manager

• Express Scripts : Premier PPO, Select PPO, Value PPO, HMO Illinois
• Cigna Rx : Cigna International

Stop Loss

Out of pocket prescription expenses limited to $1,500 per calendar year per family member for Premier PPO, Select PPO and HMO Illinois participants.  

Dispensing Limits

For certain drugs, the plans normally provide coverage up to specified dispensing limits. You may obtain medications above specified dispensing limits but will be responsible for paying for the additional quantity. 

Prior Authorization

Before a health plan will cover quantities of a medication above established dispensing quantities, your physician may be required to obtain prior approval from the health care plan.

Individuals may obtain approval when the member's physician speaks with the PBM. Physicians are familiar with these procedures.

Prior authorization inquiries need to be directed to Express Scripts at 1-800-889-0376 (fax 952-837-7181).  The prior authorization code is K9E123.