Prescription Coverage
UofL's Prescription coverage helps ensure you have affordable access to necessary medications to manage both short‑term and chronic conditions.
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Express Scripts, the company managing your prescription drug benefit, provides 24-hour customer service, web-based drug information, and an integrated mail/home pharmacy service.
Prescription Copays
You have the option to receive your maintenance medication through the retail pharmacy or delivered to your home. Here’s how prescription drug coverage is offered by Express Scripts. The annual deductibles are different from one another by plan:
PPO and ULH:
Prescription drugs are not subject to a deductible and only apply toward the out-of-pocket maximum. Refer to the chart on the next page for copay amounts and maximum costs.
CDHP:
You have one deductible for your medical and prescription drug expenses. Your prescription drugs are not covered until you reach your full annual deductible for the year.* It’s very important to understand the full cost of your prescription drugs because you will pay the full cost until you meet your annual deductible.
*Under the CDHP, prescriptions for select preventive medications will bypass the deductible and the copay will apply before satisfying the deductible. Medications that are on the preventive list and bypass the deductible, will still have a cost and that cost will apply to the maximum out-of-pocket accumulator but will not apply to the deductible. For more information, please contact KY Rx Coalition at 855-218-KYRx or online at kyrx.org.
For your convenience, your Anthem ID card will be a combination ID card for medical and Express Scripts prescription coverage.
Express Scripts Pharmacy Home Delivery
Enjoy the convenience- your prescriptions come directly to you with FREE shipping! If you or a covered dependent take an ongoing medication, you will spend less money with added convenience through the Select Home Delivery program.
Select Home Delivery is encouraged after two fills on maintenance medications defined by Express Scripts. UofL insured members must make an active choice if selecting to use either retail pharmacy or Express Scripts mail order pharmacy for maintenance medications (those you take regularly for chronic conditions).
For Home Delivery option, contact the Kentucky RX Coalition or elect Home Delivery from Express Scripts Pharmacy website. With home delivery:
- You get select generic maintenance prescription drugs at no cost to you.
- You pay less for your brand formulary and nonformulary 90-day prescriptions (see chart on next page).
- You get free shipping.
- You get prescriptions delivered straight to your door.
For home delivery for your medications, not just maintenance medications, contact the Know Your Rx Coalition or elect home delivery from Express Scripts at express-scripts.com.
Insured members who “opt out” of using Select Home Delivery mail order for medications will only need to do so one time. Members will not be required to renew the Home Delivery Option annually. Contact Express Scripts at 1-800-298-6890 or Express Scripts Mail Order at 1-800-298-6890.
Kentucky Rx Coalition
The Kentucky Pharmacy Coalition provides pharmacy benefit contracting through a group purchasing agreement. In addition to accessing pricing arrangements, the Kentucky Pharmacy Coalition will help control prescription costs for covered employees and their covered dependents.
Kentucky RX Coalition committed to helping you save money whenever possible. To use your University of Louisville prescription benefit, present your Express Scripts prescription benefit ID card at your pharmacy, and ask if there are any special pricing programs they offer on any medications.
Help with Your Medicine & Copay Counseling: Free prescription counseling services are available for any University of Louisville health plan member. You may phone Kentucky Rx Coalition pharmacists with questions regarding prescriptions and over-the-counter medications, and advice on how you may save money on your prescriptions. To access prescription drug counseling, phone 1-855-218-5979 (KY Rx) or 859-218-KY Rx (5979).
Who to call with prescription issues
Express Scripts | Ky RX Coalition |
|---|---|
| When you need ID cards | When you can’t reach Express Scripts |
| To enroll in mail order | To find lower cost alternatives |
| To find an in-network pharmacy | To contact your physician for Rx for lower cost alternatives |
| To price check an Rx | To help with mail order |
| To ask about side effects, drug interactions, and over the counter medications |
How to Fill Your Prescription at a Retail Pharmacy
Present your Express Scripts identification card at a participating pharmacy in the Express Scripts national network.
Prescription ID Card
Employees enrolled in a health plan will receive one combination ID card for health and Express Scripts benefits for each covered member. You must present your medical ID card for pharmacy benefits. Enrollment in the prescription plan is automatic when you elect a health plan.
Formulary
The Express Scripts formulary for UofL is available online at www.express-scripts.com. The formulary may change during the year when:
- A generic drug becomes available to replace the brand name drug, or
- A drug becomes available over the counter (no longer covered under the pharmacy benefit, or
- New drugs approved.
Contact Express Scripts
Express Scripts Member Customer Service 1-800-298-6890
Website www.express-scripts.com
Frequently Asked Questions
Our pharmacy benefits provider has contracts with the drugs listed on our formulary brand (similar to in-network with insurance). It does not have contracts with non-formulary brands, so we cannot get a discount (similar to out-of-network with insurance). Since non-formulary brands cost more, employees must share this increased cost.
Always speak with your medical provider who is writing the prescription to see if there is a generic or a formulary branded drug that is available. This will save you time and trouble when you get to the pharmacy and realize that the medication is not covered.
You have two choices in finding this information. You can either contact Know Your Rx Coalition or Express Scripts.
Specialty drugs are injectable, infused, oral or inhaled therapies that often require special delivery, handling, administration and monitoring. Therefore, our Specialty Pharmacy must be used because they meet these criteria.
Yes, covered drugs are subject to plan limitation and exclusions. Some drugs may require prior authorization or step therapy. The Plan formulary lists whether a drug requires prior authorization or has a specific quantity limit.
Fill your maintenance medications for a 90-day supply and get them through home delivery. Consider over-the-counter drugs and always ask for a generic drug if it is available from your doctor or pharmacist.