CMU's Express Scripts Prescription Coverage

Benefits Flex PD20/50 (Express Scripts) Flex PD10/20/30 (Express Scripts) Flex PD10/30 (Express Scripts)
Generic Prescriptions 20% co-pay after  deductible; must be filled at an In-Network Pharmacy. 10% co-pay for generics; must be filled at an In-Network Pharmacy.* *This plan fills automatically with a generic prescription if a generic is available. 10% co-pay; must be filled at an In-Network Pharmacy
Brand name drug on formulary. 20% co-pay after deductible; must be filled at an In-Network Pharmacy. 20% co-pay using an In-Network Pharmacy if there is no generic equivalent drug available . *If a brand drug is used and the brand drug has a generic equivalent, the cost to the employee will be the difference between the brand cost and the generic cost plus the applicable brand co-pay (20%) of the full cost of the brand drug. 10% co-pay; must be filled at an In-Network Pharmacy.
Brand name prescription not on the formulary. 30% co-pay after deductible; must be filled at an In-Network Pharmacy. 30% co-pay; must be filled at an In-Network Pharmacy if there is no generic equivalent drug available . *If a brand drug is used and the brand drug has a generic equivalent, the cost to the employee will be the difference between the brand cost and the generic cost plus the applicable brand co-pay (30%) of the full cost of the brand drug. 30% co-pay; must be filled at an In-Network Pharmacy.
Mandatory Generic Plan No, this is a Dispense As Written (DAW) Plan Yes, this is a mandatory generic plan No, this is a Dispense As Written (DAW) Plan
Out-of-Network Pharmacy 50% co-pay after deductible. 50% co-pay. 50% co-pay.
Deductible $50 per member; $150 maximum for family per plan year. None None
Annual Maximum $5,000 annual maximum;  30% co-pay for amounts between $5,000-$10,000. $10,000 annual maximum;  30% copay for amounts between $10,000-$15,000. $10,000 annual maximum; 30% co-pay for amounts between $10,000 - $15,000.
University Health Services (UHS) - 
3-month supply of refillable maintenance prescriptions program. 		Yes, will receive a one-month supply the first time filling a maintenance prescription at UHS. Yes, will receive a one-month supply the first time filling a maintenance prescription at UHS. Yes, will receive a one-month supply the first time filling a maintenance prescription at UHS.
Mail Order Available Yes, toll free access to mail order pharmacy at 1-877-412-6121. $50 deductible is waived with mail order prescriptions; just co-pay with mail order. Yes, toll free access to mail order pharmacy at 1-877-412-6121. Yes, toll free access to mail order pharmacy at 1-877-412-6121.
Drug Exclusions Experimental drugs, appetite suppressants, anorexiants (weight control), Rogaine, over-the-counter products, devices and implants, any drug not FDA approved, drugs used for cosmetic purposes, injectable drugs other than insulin, fertility agents, legend multivitamins and supplemental agents. Experimental drugs, appetite suppressants, anorexiants (weight control), Rogaine, over-the-counter products, devices and implants, any drug not FDA approved, drugs used for cosmetic purposes, injectable drugs other than insulin, fertility agents, legend multivitamins and supplemental agents. Experimental drugs, appetite suppressants, anorexiants (weight control), Rogaine, over-the-counter products, devices and implants, any drug not FDA approved, drugs used for cosmetic purposes, injectable drugs other than insulin, fertility agents, legend multivitamins and supplemental agents.
Oral Contraceptives (birth control pills) Yes Yes Yes
Restrictions Growth hormones, Biotech, and genetically engineered drugs are restricted.  If medically necessary, subject to pre-authorization process. Growth hormones, Biotech, and genetically engineered drugs are restricted.  If medically necessary, subject to pre-authorization process. Growth hormones, Biotech, and genetically engineered drugs are restricted.  If medically necessary, subject to pre-authorization process.
Drug Utilization Review On-line electronic Point of Sale Claims Management system to check for the following:
  • duplicate prescriptions
  • therapeutic duplication
  • incorrect dosage
  • too early refill
  • drug interactions/allergies
  • drug to age conflict
  • compliance check
On-line electronic Point of Sale Claims Management system to check for the following:
  • duplicate prescriptions
  • therapeutic duplication
  • incorrect dosage
  • too early refill
  • drug interactions/allergies
  • drug to age conflict
  • compliance check
On-line electronic Point of Sale Claims Management system to check for the following:
  • duplicate prescriptions
  • therapeutic duplication
  • incorrect dosage
  • too early refill
  • drug interactions/allergies
  • drug to age conflict
  • compliance check

For instructions on how to start receiving prescriptions by mail, visit Express Scripts Mail Prescription Pharmacy.

Frequently Asked Questions