Menu

PHARMACY BENEFITS

PHARMACY BENEFITS

Resources
RxBenefits Member Portal Registration Booklet
Member Portal

Rx Benefits

Hudson City School District’s prescription benefit is through RxBenefits. Please review the chart below on the benefits.

Note: Members may contact RxBenefits Member Services at 1.800.334.8134 or visit express-scripts.com . If there are any additional questions, please contact your Human Resource Department.

Prescription Drug Benefit
Retail Pharmacy Coverage (01-30 Day Supply) In Network Pharmacy
Generic
$25.00
Preferred Brand
 $30.00
Non-Preferred Brand
$40.00
Retail Pharmacy Coverage (31-90 Day Supply)  In Network Pharmacy
Maintenance Generic $50.00
Maintenance Preferred Brand $60.00
Maintenance Non-Preferred Brand $80.00
Retail Pharmacy Coverage (01-90 Day Supply)  In Network Pharmacy
Diabetic Supplies $0.00
Low Cost Generic List $10.00
Mail Order Extended Supply (01-90 Day Supply)  In Network Pharmacy
Generic $50.00
Preferred Brand $60.00
 Non-Preferred Brand $80.00
Diabetic Supplies $0.00

Accumulations
MOOP Embedded
$500.00 / $1,000.00 Family
The Calendar year MOOP applies to pharmacy claims. Each individual family member must meet the individual MOOP unless the family MOOP has been met by any two or more covered family members. Once met, your covered prescriptions are paid at 100%. Generic Dispense as Written policy does not apply to the MOOP.

 

Specialty Medications

Specialty medications are high-cost drugs that are often injected or infused and require special storage and monitoring. These medications must be obtained through Accredo specialty pharmacy by calling Accredo at 1.800.803.2523. Some exceptions apply. These medications are limited to a 30 day supply. Specialty medications largely fall into the formulary brand category but could also fall into the biosimilar or generic specialty drug category. These medications are subject to the appropriate copay as listed below. Accredo Specialty Pharmacy also offers pharmaceutical care management services designed to provide you with assistance throughout your treatment.

Specialty Medication

 Accredo
Specialty Generic
$25.00
Specialty Preferred Brand
 $30.00
Specialty Non-Preferred Brand
$40.00

 

 
Retail and Mail Order Pharmacies

Hudson City Schools participates in the Express Scripts pharmacy network. Contact RxBenefits Member Services at 1.800.334.8134 to inquire about a specific pharmacy.

Generic Policy – Dispense As Written (DAW)

If you choose to buy the Brand name drug when a Generic equivalent is available, you will be required to pay the Generic copay/coinsurance plus the difference in cost between the Generic and Brand name drug.

Maintenance Drug

A medication that is used for chronic health conditions on an ongoing or long-term basis (e.g., antihypertensive medication taken daily to control high blood pressure). Your plan allows maintenance medications to be filled in 90-day supplies by mail order pharmacy or at a retail pharmacy location.

Manufacturer Copay Assistance Program (MCAP)

Specialty medications are used to treat complex chronic conditions and have a high cost. Your employer is offering a copay assistance program coordinated by SaveOnSP. Enrolling in the program provides the opportunity for $0 cost on select specialty medications. If you choose not to enroll, your responsibility will be a 30% coinsurance. Please contact SaveOnSP at 800.683.1074 so a patient advocate can assist you with completing your enrollment.

Preventive Medications

Your employer’s plan is subject to the Affordable Care Act (ACA) which requires the coverage of a number of preventive items and services at 100% and ensures these items and services are not subject to deductibles, maximum out of pockets, or other limitations such as annual caps or limits. You may contact RxBenefits Member Services at 1.800.334.8134 if you have specific drug questions or register at express-scripts.com to check drug costs and coverage.

Compound Drugs

For compound drugs to be covered, they must satisfy certain requirements. In addition to being medically necessary and not experimental or investigative, compound drugs must not contain any ingredient on a list of excluded ingredients. Any denial of coverage of a compound drug may be appealed in the same manner as any other drug claim denial under this coverage. Compounded medications equal to or exceeding $300 per script will require prior authorization.