Express Scripts Copay
- For details on what is considered “preventive care,” contact Express Scripts. Retail: 20% of the cost; minimum $5 copay and $40 maximum (up to a 30-day supply) Home delivery: $10 copay (31- to 90-day supply) Preferred Brand Name. Retail: 20% of the cost.
- Up to $750.00 maximum copay /script Above applies until MOOP is reached. 90-day Supply Express Scripts By Mail (Home Delivery) Using Express Scripts By Mail Tier 1 - Generics - no cost to member Tier 2 - 25% coinsurance up to $300.00 maximum copay / script Tier 3 - 33% coinsurance up to $600.00 maximum copay / script.
Express Scripts also disclosed some startling savings from SaveonSP, an offering run by a secretive private company. As I explain below, SaveonSP declares specialty drugs to be “non-essential health benefits” and then extracts funds from manufacturers’ copay programs to pay for the drugs anyway. Express Scripts Medicare Choice is a 3.5 Star Medicare Part D Plan for Medicare Beneficiaries in Hawaii. According to the Centers for Medicare and Medicaid Services (CMS), this prescription drug plan's quality is Average, and rated it 3.5 out of 5.0 stars. These are the areas of the plan that are important to compare and review. Your health and safety is our top priority and at the heart of what we do. Whether you’re a longtime customer of the Express Scripts ® Pharmacy or you turned to us recently during the COVID-19 pandemic, we’re here to serve you, 24/7. Our commitment to you is stress-free prescription management, reliable delivery, and world-class pharmacy care from specially-trained pharmacists.
The Kroger Family of Pharmacies includes Dillons, Fred Meyer, Fry's, Harris Teeter, King Soopers, Mariano's, Metro Market, Pick 'n Save, QFC, Ralphs and Smith's.
Premiums may vary by plan and region.
Other pharmacies are available in our network. Preferred pharmacies agree to charge less for certain prescription drugs. You may use any network pharmacy in your plan, but you will typically pay less when you use a preferred retail pharmacy or preferred home delivery from Express Scripts Pharmacy®.
Medicare Part B prescription drugs are not covered under the prescription drug benefit (Part D). Generally, we cover only prescription drugs, vaccines, biological products and medical supplies that are covered under the Medicare prescription drug benefit (Part D) and that are on our formulary.
Does Express Scripts Accept Copay Cards
Express Scripts Medicare’s pharmacy network includes limited lower-cost, preferred pharmacies in rural areas in Alaska; the Saver plan also includes limited lower-cost, preferred pharmacies in suburban areas in Puerto Rico, and the Choice plan also includes limited lower-cost, preferred pharmacies in rural areas in Oklahoma. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, please call Customer Service at 1.866.477.5703; TTY: 1.800.716.3231, or consult the online pharmacy directory.
Certain prescription drugs will have maximum quantity limits.
Your prescriber must get prior authorization from Express Scripts Medicare for certain prescription drugs.
Covered Part D drugs are available at out-of-network pharmacies under certain circumstances, including illness while traveling outside the plan's service area, where there is no network pharmacy. You may also incur an additional cost for drugs received at an out-of-network pharmacy.
We have free interpreter services available to answer any questions you may have about the plan. View information on multi-language interpreter services.
Express Scripts Medicare (PDP) is a prescription drug plan with a Medicare contract.
Enrollment in Express Scripts Medicare depends on contract renewal.
Medicare Part D Formulary (drug list)
A formulary is the list of drugs covered by a Part D plan. Medicare requires all Part D plans to cover at least two drugs in each therapeutic drug category.
Express Scripts Medicare plans typically cover the drugs listed in the formulary, as long as:
- The drug is medically necessary
- The prescription is filled at one of our network pharmacies
- Any special drug coverage rules are followed, as required
Some types of drugs are not covered by Medicare Part D, such as drugs for weight loss or cosmetic purposes.
Express Scripts Discount Card
The level of coverage for each drug will depend in part on which tier the drug is in. You can find more information about drug tiers in the Evidence of Coverage and formularies listed below.
Tier 1 Preferred Generic Drugs
Tier 2 Generic Drugs
Tier 3 Preferred Brand Drugs
Tier 4 Nonpreferred Drugs
Tier 5 Specialty Tier Drugs
Tier 6 Select Care Tier Drugs (Value and Choice plans only)
NEW! Part D Seniors Savings Model
Express Scripts Medicare offers insulin at an affordable and predictable price with our Saver and Choice plans. You will pay $35 or less for select insulin medications from any network pharmacy, in all stages up to the Catastrophic Coverage Stage. View a list of the included drugs. If you receive 'Extra Help,' you do not qualify for this program, and your Low-Income Subsidy copay level will apply.
To view and/or print our formulary now, click on the plan option below:
You may also access our online searchable tool to confirm if your drugs are covered and to see if there are any special coverage rules.
To request a comprehensive formulary be mailed to you, send an email with your full name, phone number and mailing address to documents@express-scripts.com. For assistance, call 1.866.477.5703, 8 a.m. to 8 p.m., 7 days a week, except Thanksgiving and Christmas. TTY users, call 1.800.716.3231.
Special drug coverage rules
Some drugs have special coverage rules that may:
- Limit the amount of a particular drug you can get
- Require that you get prior approval from the plan before a drug is covered (known as prior authorization)
- Require that you first try a certain drug to treat your condition before another drug is covered (known as step therapy)
- Limit which pharmacies you can use
Drugs that are subject to these rules are clearly marked in the formulary.
View the list of prescription drugs that currently have prior authorization or step therapy requirements and the rules that apply to each drug:
Saver plan
Value plan
Choice plan
Once coverage begins, you may request an exception to our coverage rules. Learn more about exceptions and appeals.
Formulary changes
Express Scripts Medicare plans may periodically:
- Add a drug to or remove a drug from the Drug List
- Move a drug to a higher or lower cost-sharing tier
- Add or remove a restriction on coverage for a drug
- Replace a brand-name drug with a generic drug
If we make certain changes to our formulary for a drug you are taking, we will either notify you at least 30 days before the change is made or notify you after the change is made and give you a 30-day refill of the drug at a network pharmacy.
If the U.S. Food and Drug Administration finds that a drug on the formulary is unsafe, or if the drug's manufacturer removes the drug from the market under Medicare Part D regulations, we immediately remove the drug from our formulary and then notify you of the change.
For additional information on formulary changes, please review Chapter 3 of the Evidence of Coverage.