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Using Express Scripts

Be sure to use your Express Scripts ID card when filling prescriptions. Your out-of-pocket costs are based on one of three tiers: generic, brand preferred, and brand non-preferred. ORNL participates in Express Scripts National Preferred Drug Formulary.

The preferred drug formulary includes over 1,800 drugs that may cost less than the non-preferred drugs that are not included in the formulary.

Copayments

For those in the Coinsurance phase of the Consumer Choice plan, Rx coverage begins after your deductible is met ($1,700 individual/$3,400 all other coverage levels). Your share of the cost (after the deductible is met) is 20% coinsurance with the minimum and maximums noted in the table below.

Surest has no deductible – instead, you pay a fixed dollar amount (copay) for in-network covered services as noted in the table below. Surest is available to salaried employees only.

Both plans offer a $0 copay on preventive medications, up to a 90-day supply.

Prescription Drug Plan Copays

Plan Design UHC Consumer Choice Surest (available to salaried employees only)
Retail Pharmacy Up to 30 Days Supply
Generic $10 min
$75 max		 $10
Preferred Brand $25 min
$150 max		 $50
Non-Preferred Brand $40 min
$250 max		 $75
Retail and Mail Order Pharmacy Up to 90 Days Supply
Generic $20 min
$150 max		 $25
Preferred Brand $60 min
$300 max		 $125
Non-Preferred Brand $100 min
$500 max		 $175
Accredo Specialty Pharmacy Up to 30 Days Supply
Generic $10 min
$75 max		 $50
Preferred Brand $25 min
$150 max		 $100
Non-Preferred Brand $40 min
$250 max		 $150
Accredo Specialty Pharmacy Up to 30 Days Supply
Generic $20 min
$150 max		 $125
Preferred Brand $60 min
$300 max		 $250
Non-Preferred Brand $100 min
$500 max		 $375

Certain rules may apply to your prescription such as prior authorizations, step therapy, Smart 90 exclusive or Member Pays the Difference. NOTE: When you use the price a medication tool, you will be alerted if any of these rules apply.

ORNL participates in the following programs to help keep prescription costs as low as possible.

Prior Authorization

Certain prescription drugs may require a prior authorization to receive the prescription or full quantity that your doctor prescribes. If your drug requires this step, your doctor may need to provide additional information to Express Scripts before the drug may be covered under your insurance plan.

Smart 90 Exclusive

This program requires members to fill maintenance medications at any network retail pharmacy or through the Express Scripts home-delivery pharmacy, and at a 90-day supply. You can get up to three 30-day courtesy fills before you must make the switch to a 90-day supply. After three 30-day courtesy fills of a maintenance prescription, if you do not fill at a 90-day supply, you will pay the full cost of the medication and the cost of the prescription will not apply towards your deductible or out-of-pocket maximum.

Member Pays the Difference

This program is designed to incentivize members to select less expensive generic equivalents when available. If the member chooses to stay on the brand name drug, whether doctor or patient requested, the member will have to pay for the difference between the gross costs of the brand name drug and the generic drug, in addition to the generic copay/coinsurance. This cost difference will not be applied towards your deductible or your out-of-pocket maximum. If there is a clinical reason why the member cannot take the generic drug, there is an Express Scripts appeal process for approval to pay only the brand name copay/coinsurance.

Learn More

To find a local participating pharmacy, compare prescription medication costs, manage your prescriptions online and view the National Preferred Formulary Exclusion List, visit express-scripts.com/ornl, download the Express Scripts Pharmacy Mobile App, or call the Enrollment Line (24/7) at 866-749-0097. You can register for Express Scripts here.