Travelers Prescription Drug Plan for 2013
For 2013, Travelers prescription drug plan will continue to incent you to utilize lower cost generic medications when appropriate and take advantage of the value and convenience offered through home delivery (mail order pharmacy) when you’re taking a drug on an ongoing basis. This site was created to estimate your out-of-pocket prescription drug costs for 2013. In a few simple steps, you'll be able to:
Review the details of your Prescription Drug Benefit, including participating pharmacies and a list of drugs covered by your plan's formulary
Build a list of the prescription drugs used by you and your family
Learn how much each drug may cost and estimate your out-of-pocket costs for the year
Determine how much money you might save by switching to a generic drug or by ordering your prescriptions through Express Scripts Mail Service
Learn about the next steps you can take to effectively manage your out-of-pocket costs
90 Day Prescription Drug Supply at Retail through CVS & Walgreens/Duane Reade Pharmacies
Plan participants can fill a 90-day prescription at CVS & Walgreens/Duane Reade retail locations nationwide. Under this option, participants will:
Need to submit a 90-day prescription at a CVS or Walgreens/Duane Reade pharmacy
Pay the equivalent of three retail copays for generic drugs ($21) OR pay the coinsurance for brand-name drugs (a minimum brand cost of $96 and a maximum brand cost of $390).
Click here to see FAQs related to this program.
Preferred Home Delivery Policy
Under this policy, you are allowed to receive up to a 1-month supply of a maintenance medication two times from any participating retail pharmacy. After two fills, you will need to make a decision to either use the Express Scripts Mail Order Pharmacy, or continue to use a retail pharmacy for refills. Any additional retail refills of the same maintenance medication will be subject to an additional 10% coinsurance above the regular coinsurance (e.g. generic, formulary brand, or non-formulary brand). Once the initial maintenance medication prescription is filled, you will receive a reminder letter from Express Scripts about this program.
The Preferred Home Delivery policy eliminates the cost difference between retail and mail pharmacy pricing for maintenance medications, while giving you the opportunity to decide where you would like to source your maintenance medications.
Note: The Preferred Home Delivery policy does not apply to 90 day supplies of maintenance medications filled at CVS or Walgreens/Duane Reade pharmacies.
In addition, selected medications may not be available through the mail order pharmacy due to manufacturer direction or medical policy. You can review the cost differences between retail and mail order prescriptions for a specific medication by visiting either of the Express Scripts Web sites described earlier. For specific questions concerning Express Scripts, call 877.494.7472.
Additional information on Express Scripts mail order pharmacy is available at www.express-scripts.com.
Click here here to see the full list of maintenance drugs subject to this policy.
Click here to see FAQs related to this policy.
Generics Preferred Policy
The Generics Preferred policy applies to all prescription categories with the exception of Coumadin and Synthroid.
The policy is triggered when a member receives a brand name prescription for a medicine when a chemically equivalent generic alternative is available. 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 copay. The ancillary charge is the difference in cost between the brand and generic drug. Ancillary charges apply and are the responsibility of the member, regardless of whether the “Dispense as Written” box is checked by the doctor. The ancillary charge does not apply towards the maximum per prescription ($130 30 day retail, $260 90 day mail order, or $390 90 day retail) or the $2,350 per person out-of-pocket maximum.
If you or your family member's physician feels it is medically necessary to continue to receive the brand name version of the medication instead of the generic, the physician can call Express Scripts’ Prior Authorization Line at 800.417.8164 before obtaining your prescription. If medical necessity is approved by Express Scripts, you pay the non-formulary coinsurance for the prescription.
Click here to see FAQs related to this policy.
Specialty Medicine Program: CuraScript
Specialty medications are covered up to a 30-day supply through Express Scripts specialty medication pharmacy company CuraScript. A partial list of conditions that may result in these specialty medications includes arthritis, cancer, hepatitis, infertility, migraines, RSV, and multiple sclerosis. Under the specialty program, members are allowed two initial fills per medication at a local retail pharmacy. After that, the medications will be filled via the CuraScript mail order pharmacy. Specialty medications are subject to the same coinsurance (minimums and maximums) as retail prescriptions with the exception of infertility medications which are covered at 50% except for the High Deductible Plan. If you have questions on this program you can contact CuraScripts at 800.278.0980.
Drug Quantity Management Program
The Drug Quantity Management program is designed to make the use of prescription medications safer for plan members and make the cost more affordable for the plan and participants. Through this program, certain medication prescriptions are limited to the daily dose considered safe and effective according to guidelines from the U.S Food & Drug Administration (FDA). In addition to limiting the dispensed quantity to the daily dose considered safe and effective, the program helps control costs by avoiding the cost of “extra” medication that could go to waste. The plan will let prescriptions be filled in the quantity up to the amount allowed by the program. If your physician feels it is medically necessary for you to receive additional medication beyond the quantity allowed, they can call Express Scripts' Prior Authorization Line at 800.417.8164. During this call, your doctor and an Express Scripts representative may discuss how your medical problem requires medicine in larger quantities than your plan allows. If medical necessity is approved by Express Scripts, the allowed amount will be adjusted accordingly.
For more information including the specific medications impacted and the allowed quantities, you can review the Drug Quantity Management FAQs by clicking here.
The Step Therapy program, which was introduced in 2012, requires an initial use of a therapeutically equivalent, lower cost generic alternative. The Step Therapy program allows you and your family to receive affordable treatment and helps control prescription drug costs.
Step Therapy applies to prescriptions prescribed for the first time in the following drug categories:
New Prescriptions Filled On or After January 1, 2012:
New Prescriptions Filled On or After January 1, 2013:
- Proton-pump inhibitors for acid reflux
- Tetracycline and topical medications for acne
- Nasal steroids for allergies
- Hypnotics for insomnia and COX-2 and non-steroidal anti-inflammatory drugs (NSAIDS) for pain.
In Step Therapy, the covered drugs you take are organized in a series of "steps", with your doctor approving and writing your prescriptions. The program starts with generic drugs in the first "step". These generics, which have been rigorously tested and approved by the FDA, allow you to begin treatment with safe, effective drugs that are also affordable: Your copayment is usually the lowest with a first-step drug. If required, more expensive brand-name drugs are covered in the "second-step". You doctor is consulted for approval and writes your prescriptions based on a list of Step Therapy drugs covered by the formulary.
- Topical corticosteroids and topical immunomodulators for skin conditions
Click here for a list of Step Therapy FAQ's.
Click here for information on the Step Therapy Drug List.
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