Medco merges with Express Scripts

In 2011, our prescription vendor Medco along with Express Scripts announced their intentions to merge.  As of April 2012, the acquisition of Medco by Express Scripts became complete.  We as a business know changes and consolidations take time.  This consolidation will be no different.  At this time there are no participant facing  changes.  Members continue to have access to the same medications, pharmacies and clinical experts.  There will be no change to pharmacy benefits as a result of the merger.  Members will continue to use the same phone number, website and mobile app they have used in the past to manage their account.  The eventual, combined offering will focus on products that provide the most value to clients and the most advanced care to members.  Look for more to come in 3rd Quarter 2012.

Prescription Drug Plan

Word to the Wise: Ask your doctor to prescribe generics whenever possible. Generic drugs are chemically identical to their brand-name counterparts, but cost significantly less.

Mandatory Generics

If you opt to take a brand-name prescription when a generic equivalent is available, you will pay more. You will be charged the difference between the brand-name drug and the generic equivalent, plus the $7 generic copay. Many brand-name drugs have generic equivalents. Generic drugs are required by the Food and Drug Administration (FDA) to have the exact same active ingredients and meet the same quality standards as the brand-name drug. In addition generics cost an average of six times less than the brand-name drug, yet are just as safe and effective.

For example, if you receive a prescription for acid reflux and opt for the brand-name drug Prilosec instead of the generic equivalent, omeprazole, you will pay more. A 30 day prescription of Prilosec costs $251.39 while the same quantity of omeprazole costs $26.87. If you fill your prescription with Prilosec, you will pay the retail generic copay of $7 plus the cost difference between omeprazole and Prilosec ($251.39-$26.87 = $224.52)/ Because there is a 30-day per- script retail maximum of $100, you will be required to pay $107 for Prilosec instead of only $7 for the generic omeprazole. If you have a reason for not using the generic equivalent, such as you are allergic to an ingredient in the generic drug, you may appeal to Medco by call 800.841.5403.

Prescription drug benefits are administered by Medco for the Aetna Consumer Advantage HDHP, PPO Medical Plans and Out-of-Area plans. For most plans, your prescription drug costs (after your deductible, if applicable) are as follows - for 2012 see new mandatory requirement above:

	You pay	Maximum you pay per prescription
Retail (up to 30-day supply)	$7 for generic drugs 30% of cost for brand name formulary 45% of cost for brand name non-formulary	$100
Mail-order (up to 90-day supply)	$14 for generic drugs 30% of cost for brand name formulary 45% of cost for brand name non-formulary	$250

Under the High Deductible Health Plan (HDHP), your medical plan annual maximum applies to your prescription drug costs. Under all other plans, you need to continue to pay your prescription drug copays and coinsurance after you reach your annual out-of-pocket maximum.

 

Mail-Order Service

If you are a new participant, you will receive a welcome kit in the mail that includes a mail-order form. You may also find order forms and additional information under Medco (click on Pharmacy Benefits) member site. You will need to register if you have not done so already.

$10 Medco Mail-Order Drug Program

More than 400 generic drugs are available at $10 or less for a 90-day supply, including drugs in the following categories:

• Asthma
• Blood Pressure
• Cold and allergy
• Diabetes
• Heartburn
• High cholesterol
• Mental Health
• Vitamins and electrolytes
• Women's health
• Thyroid therapy
• Skin conditions

Instead of going to your local grocery store, you can mail in your prescription (if on the Medco list) and receive a discount. You also can conveniently reorder your prescriptions online. Medco will send you a reminder to let you know it is time to reorder your prescription.

To find out if your generic medication is included, go to www.medco.com/lowcostgenerics or call the toll-free number on your prescription drug ID card.

Mail Order Incentive Program

This program encourages you to get your long-term medications through the Medco mail-order program.

If you decide to purchase your long-term drugs at a participating retail pharmacy instead, you will pay more after the third time. The first three times, you will pay your regular 30-day supply copayment or coinsurance.*

Beginning with the fourth time you fill a long-term prescription at a participating retail pharmacy, you will pay the following:

	You pay for a 30 day supply**
Drug type	Regular Prescriptions
Generic	$14
Brand Formulary	50%***
Brand Non-Formulary	100%***