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Prescription Drug Benefits

All four Northwestern-sponsored medical plans provide benefits toward the cost of prescription drugs. Express Scripts is the Pharmacy Benefit Manager for all four plans.

You can price medications, do a formulary look up, find participating pharmacies, and review plan highlights on the Express Scripts website.

Copays

Retail, one month supply

Prescription drug costs for a one-month retail supply by plan type.
Premier PPO, Select PPO and HMO Illinois Value PPO

You pay a copay of:

  • $10 for each generic drug prescription
  • $30 for each preferred brand name drug prescription
  • $60 for each non-preferred brand name prescription
  • $90 for each specialty drug prescription
  • You pay the full cost of all prescription medications until you meet the plan's annual deductible
  • After that, you pay 20% of your prescription drug costs (coninsurance) until your total out-of-pocket expense reach the plan's annual out-of-pocket maximum

 

Home delivery, three month supply

Prescription drug costs for a three-month home delivery supply by plan type.
Premier PPO, Select PPO and HMO Illinois Value PPO

You pay a copay of:

  • $20 for each generic drug prescription
  • $60 for each preferred brand name drug prescription
  • $120 for each non-preferred brand name prescription
  • $180 for each specialty drug prescription
  • You pay the full cost of all prescription medications until you meet the plan's annual deductible
  • After that, you pay 20% of your prescription drug costs (coninsurance) until your total out-of-pocket expense reach the plan's annual out-of-pocket maximum

Smart90: Required 90-Day Supply

This program will apply to select long-term medications, which will now require a 90-day supply. With Smart90, you can conveniently fill these prescriptions with a 90-day supply either through home delivery from the Express Scripts Pharmacy or from any CVS, Walgreens or Duane Reade pharmacies.

If you keep filling a 1-month supply of the listed long-term medications at a nonparticipating pharmacy, you could pay more. For example, if a drug costs $75, even if your copay or coinsurance is only $20, you could pay up to the full $75.

For more information on Smart90, Click Here

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.

 

If you are prescribed a specialty drug

Prescriptions for all Specialty Drugs must be filled through Accredo mail order. They cannot be filled at a retail pharmacy.

Accredo – a wholly owned subsidiary of Express Scripts – is a mail-order pharmacy whose sole purpose is specialty medication management. Accredo fills prescriptions for Specialty Drugs for oral, injectable, and infused medications and provides on-call nurse and pharmacist support for patients on these complex, expensive drugs.

Because many Specialty Drugs require refrigeration, Accredo takes precautions to ensure product preservation, including using temperature-controlled packaging and working with patients to arrange for safe and secure package delivery. For example, if you are unable to receive your medications at home, you may request delivery to your workplace, your doctor’s office, or a family member’s home.

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