Prescription Plan

The County’s prescription medication coverage plan is administered by Express Scripts and their specialty pharmacy Accredo. Employees enrolled in the County’s medical plan are automatically enrolled in the prescription plan. Employees who decline or opt out of medical plan coverage are not eligible for the prescription plan. Prescription coverage is included in the medical deduction from your paycheck.

---

Filling Prescriptions

Applies to Both Medical Plans

• 30-day supplies of medications may be filled at any participating pharmacy.
• 90-day supplies of long-term maintenance medications must be filled at Walgreens or by Express Scripts home delivery.
• Specialty medications for complex conditions such as cancer must be filled by Accredo, the Express Scripts specialty pharmacy, which provides home delivery.

---

30-Day Supply of Medication

Open Access Plus (OAP)

If you are enrolled in the OAP Plan, generic drugs have a copay and brand drugs are subject to coinsurance within a specified range:

Open Access Plus (OAP) Plan: Up to 30-Day Supply

Prescription Type	Your cost	Minimum	Maximum
Generic	$15 copay	N/A	N/A
Preferred Brand	20% coinsurance	$30	$60
Non-Preferred Brand	40% coinsurance	$45	$90
Preferred Specialty Brand	20% coinsurance	$60	$120
Non-Preferred Specialty Brand	40% coinsurance	$90	$180

Example: Bob has a 30-day supply of a preferred medication. Regardless of the contracted rate, he will pay at least $30 but not more than $60. 

---

Choice Fund Open Access Plus HSA (Health Savings Account)

If you are enrolled in the HSA plan, there are no copays. Your pharmacy costs are applied to your deductible. Once the deductible is met, you pay 20% coinsurance, as shown below:

Choice Fund Open Access Plus HSA Plan: Up to 30-Day Supply

Prescription Type	Your Cost
All drugs (generic, preferred, non-preferred, or specialty)	The contracted rate up to the deductible, then 20% coinsurance
Preventive drugs	No charge*

*For the Choice Fund Open Access Plus HSA Plan, medications on the Preventive Medicine List are free of charge for 30-day supplies at the pharmacy of your choice, except Walgreens and Express Scripts home delivery which require 90-day supplies per the Smart90 Program.

• Example #1: Jennifer has not met her deductible. She has a 30-day supply of a preferred medication with a contracted rate of $175. Because Jennifer has not met her deductible, she will pay the full contracted rate of $175. 
• Example #2: John has met his deductible.  He has a 30-day supply of a non-preferred specialty medication with a contracted rate of $300.  John’s cost for a 30-day supply is $60 ($300 X 20% coinsurance = $60). 

---

90-Day Supply of Medication (Smart90)

• The Smart90 Program applies to long-term medications for chronic conditions such as high blood pressure, diabetes and depression.
• If you have a prescription for a long-term maintenance medication used on an ongoing basis (three months or longer) you need to fill it for a 90-day supply at a Walgreens store or through Express Scripts home delivery, or you will pay the full retail cost of the medication.
• Smart90 does not apply to new prescriptions or medications unavailable in 90-day quantities.
• For more information, see the Smart90 FAQs.

OAP and Choice Fund Open Access Plus HSA Plans: Up to 90-Day Supply

Prescription Type*	Your Cost with Smart90 (Walgreens or Home Delivery)	Your Cost with Another Pharmacy
Non-Specialty Brand	2 times the cost of 30-day supply	Full retail cost
Specialty Brand	Cost of 30-day supply	Full retail cost

*For the Choice Fund Open Access Plus HSA Plan only, drugs on the Preventive Medicine List are free of charge for 90-day supplies if filled at Walgreens or Express Scripts home delivery.

Example for the OAP Plan: Sarah has a prescription for a 90-day supply of a preferred maintenance medication. The retail cost is $200 for a 30-day supply. Sarah’s cost for a 90-day supply at Walgreens or Express Scripts home delivery is $80 (20% of $200 = $40 X 2 = $80). If Sarah fills her 90-day prescription at another pharmacy such as CVS or Publix, she will pay the full retail cost of $600 unless she finds a lower cost alternative.

---

Out-of-Pocket Maximum

• Your prescription drug payments are applied to the combined out-of-pocket maximums under both plans.
• Once you satisfy your out-of-pocket maximum, Cigna and Express Scripts pay 100% of the cost for the rest of the plan year.

---

Cost Savings

• You are encouraged to take advantage of lower prices for 30-day or 90-day supplies of medications when available. You can use cost-saving options with Smart90.
• Some ways to save money are:
  • Go to a store that offers medications at a lower cost
  • Use a discount card
  • Request assistance from the drug manufacturer
  • Utilize a manufacturer coupon (only the amount you pay out-of-pocket when using manufacturer coupons will be applied toward your deductible and out-of-pocket maximum.)
  • View price comparison lists at websites including Express Scripts.
• Employees enrolled in the Express Scripts plan are automatically enrolled in a GoodRx plan which combines the Express Scripts pricing with the GoodRx discount card.
  • No action is needed on your part.
  • Your prescription claims will be pass through the Express Scripts system to apply a lower price from GoodRx if available.
  • Present your Cigna ID card as usual which includes Express Scripts information. You will not receive an ID card from GoodRx.

12/19/24