Prescription Costs

Effective January 1, 2023, the Medical Trust is introducing new prescription drug plan cost sharing.

The cost of prescription medications will depend on the plan an employer offers, as shown in the tables below.

See definitions of the terms used in the tables.

Express Scripts Standard Rx Option

 

Retail
(up to 30-day supply)

Home Delivery
(up to 90-day supply)

Generic

Up to $10

Up to $25

Preferred brand-name

25%; up to

$40 min / $80 max

25%; up to

$100 min / $200 max

Non-preferred brand-name and brand non-sedating antihistamines

40%; up to

$80 min / $160 max

40%; up to

$200 min / $400 max

Specialty

40%; up to

$100 min / $200 max

40%; up to

$250 min / $500 max

Express Scripts Premium Plan

 

Retail
(up to 30-day supply)

Home Delivery
(up to 90-day supply)

Generic

Up to $5

Up to $12

Preferred brand-name

Up to $35

Up to $87

Non-preferred brand-name and brand non-sedating antihistamines

Up to $70

Up to $175

Specialty

Up to $90

Up to $225

*Deductible is for Brand-Name medications

CDHP/HSA

 

Retail and Home Delivery
Prescription Drugs

Annual Prescription Deductible

Combined with Medical Deductible

Generic

15% after deductible

Preferred Brand-Name Drugs (designated by Express Scripts)

25% after deductible

Brand-Name Drugs Not on Express Scripts National Preferred Formulary and Brand Non-Sedating Antihistamines

50% after deductible

Specialty Rx list

50% after deductible

Kaiser Permanente

 

Retail

Home Delivery

Annual Deductible

(in-network)

None

None

Generic

Up to $5 Copay

Up to $5 for a 30-day supply or $10 for a 90-day supply

Preferred Brand-Name

Up to $30 copay

Up to $30 for a 30-day supply or $60 for a 90-day supply

Non-preferred Brand-Name

Up to $70 copay

Up to $70 for a 30-day supply or $140 for a 90-day supply

Specialty

Up to $90 copay

Up to $90 for a 30-day supply or $180 for a 90-day supply

Dispensing Limits

Up to 30-day supply

Up to 90-day supply

Note: Kaiser CDHP members will continue to have coinsurance-based prescription drug plan cost sharing with a combined medical and pharmacy deductible. Kaiser CDHPs will also introduce a Specialty Rx tier of 50% coinsurance after deductible.

These charts provide a general description and are provided for informational purposes only. They should not be viewed as an offer of coverage. In the event of a conflict between these charts and the official Plan documents, the official Plan documents will govern. 

Drug Categories

Generic - medications with the same active ingredients and manufactured according to the same strict federal regulations as their brand-name counterparts.

Brand-Name - a drug patented by the manufacturer and sold by its brand name.

Preferred  - generic and brand-name drugs that are preferred by your plan because they help to control rising prescription drug costs.

Non-preferred - generic and brand-name drugs that are not included on your plan's preferred list. They may be covered, but you may be required to pay a higher cost.

Specialty - typically high cost drugs that are injected or infused in the treatment of acute or chronic diseases. Specialty Drugs often require special handling such as temperature-controlled packaging and expedited delivery. Most Specialty Drugs require preauthorization to be considered Medically Necessary.

 

The Episcopal Church Medical Trust Disclaimer

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