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Pharmacy Plan
State Non-Medicare Retirees
All medical coverage includes MCHCP’s prescription drug benefits, administered by Express Scripts. Express Scripts provides a nationwide retail pharmacy network, as well as its specialty pharmacy, Accredo. Express Scripts offers home delivery for maintenance medications that can help save you time and money. You may have to pay more if you get a brand name drug when a generic is available. Express Scripts’ preferred formulary list is available on myMCHCP or by calling Express Scripts.
| Benefit Description |
HSA Plans
|
PPO Plans
|
|
Network | Non-Network |
Network | Non-Network |
| Prescription Out-of-Pocket Maximum |
Combined with Medical |
$4,150/individual
$8,300/family |
No Maximum |
| Prescription Drugs
Reduced costs for certain drugs and supplies. |
Preventive: MCHCP Pays 100%
Notes:
- Diabetic Drugs have reduced copayments (5%/10%/20%)
|
Preventive: MCHCP Pays 100%
Specialty: $100 through Accredo
Notes:
- Diabetic Drugs have reduced copayments ($7.50/$25/$60)
|
| Specialty (Up to a 31-day Supply) |
-- |
$100 through Accredo |
| Plan |
Type |
Retail Network one-month (31-day supply) |
Retail Network two-month (60-day supply) |
Retail Network three-month (90-day supply) |
Home Delivery three-month (90-day supply) |
Retail Non-Network one-month (31-day supply) |
| HSA Plan Coninsurance - after deductible is met |
Generic |
10% up to $50 |
10% up to $100 |
10% up to $150 |
10% up to $150 |
40% |
| Preferred |
20% up to $100 |
20% up to $200 |
20% up to $300 |
20% up to $300 |
40% |
| Non-Preferred |
40% up to $200 |
40% up to $400 |
40% up to $600 |
40% up to $600 |
50% |
| PPO Plans Copayment |
Generic |
$15 |
$30 |
$45 |
$37.50 |
|
| Preferred |
$50 |
$100 |
$250 |
$125 |
|
| Non-Preferred |
$120 |
$240 |
$360 |
$300 |
|