Prescription Order & Claim Forms

Plan For Your Prescription Drugs*
HMO Illinois

You pay a flat-dollar amount (copayment), as follows:

Retail (one-month supply)

$10 generic/$30 preferred brand/$60 nonpreferred brand/$90 specialty

Home delivery (three-month supply)

$20 generic/$60 preferred brand/$120 nonpreferred brand/$180 specialty

Premier PPO
Select PPO
Value PPO

You pay the full cost until you reach the annual deductible.

After that, you pay 20% (coinsurance) of the drug's cost, up to the annual out-of-pocket maximum.

*This is a reminder that effective January 1, 2013, two new programs were implemented to our prescription drug plan administered by ExpressScripts.

Generics Preferred 

Under this program, if a brand-name drug is dispensed rather than an available chemically- equivalent generic drug, an ancillary charge is applied in addition to the member’s generic coinsurance. Ancillary charges are the responsibility of the employee, regardless of whether the “Dispense as Written” box is checked by your doctor. The ancillary charge is 50% of the difference in cost between the brand and generic product. Ancillary charges do not apply towards the maximum cost per prescription or the $1,500 per person out-of-pocket maximum. It is important to remember that this program still allows you the choice between treatment options but not at an increased cost to the plan and its participants.

If you have questions about the ancillary charge for a particular brand medication you are prescribed, contact ExpressScripts.

*Please note that Prior Authorization may be required for certain medications.  When you are prescribed one of these medications, your physician will be consulted.  The Prior Authorization telephone number is 1-800-417-1764.  Provide this number to your physician if a Prior Authorization is required for your medication.

CuraScript Exclusive

Under this program, all specialty medications must be filled exclusively through CuraScript mail order.  This means specialty medications attempted to be filled at the retail level will be rejected. 

CuraScript is a wholly owned subsidiary of ExpressScripts and is a mail order specialty pharmacy, whose sole purpose is patient management with  specialty medications.  CuraScript provides specialty prescriptions, defined as injectable, oral and infused medications.  As one of the nation’s leading providers of specialty medications, CuraScript nurses and pharmacists are able to support patients who need to take these complex and expensive medications.   Since many specialty medications require refrigeration, CuraScript takes every precaution to ensure that medications are packaged in temperature controlled materials to ensure preservation.  Because the medications are dispensed by mail order, CuraScript will work with you to make arrangements to receive the package.  If you will not be home to receive your medications, you can request that they be mailed to your office, doctor’s office or a family member’s address.

As always, please contact the Benefits Division with any questions about our benefit programs.