Your Prescription Drug Benefits

Prescription drugs are often essential for maintaining our health. They also can be expensive, and they play a large role in the rising cost of health care. That's why The Texas Annual Conference of the United Methodist Church (TAC) offers a prescription drug plan as part of your medical coverage.

Who is eligible?

If you enroll in the standard PPO plan, you're automatically enrolled in the Script Care prescription drug plan.

If you enroll in the high-deductible PPO, you receive a Script Care discount card that will save you money on your prescriptions. However, you pay for your prescriptions out of your own pocket until you reach your annual deductible, after which your medical plan pays 80% of your prescription drug costs. You can reimburse yourself from your health savings account if you choose to open one.

Save more money!

You'll see the greatest savings by asking your doctor to prescribe generic equivalents of name-brand drugs whenever possible. You should also ask your doctor to prescribe from the Script Care formulary whenever possible, because non-formulary name-brand drugs are the most expensive. Please visit Script Care and create a log-in ID and password for a list of the generic equivalents to brand-name drugs.

Standard PPO prescription drug deductibles and out-of-pocket maximums

  • Under the standard PPO plan, you pay a separate annual prescription drug deductible ($50 per individual, $100 per family) before the prescription drug plan begins to pay benefits. This deductible is in addition to your annual medical plan deductible. The deductible begins January 1 each year for your prescription drug coverage.
  • Participants in the standard PPO plan will have an annual prescription drug maximum out-of-pocket expense limit of $2,000 for individuals or $4,000 for a family which includes deductibles, co-pays and co-insurance expenses.
  • The prescription drug maximum out-of-pocket expense is separate from the medical annual out-of-pocket maximums. Previously, there has been no out-of-pocket maximum for prescription drug expenses for the standard PPO Plan. This benefit does not apply to the high-deductible PPO plan since it has a separate combined medical/prescription drug out-of-pocket maximum.

How the Script Care prescription drug plan works

  • To receive full benefits, you must use a participating pharmacy—which shouldn't be a problem, because more than 60,000 pharmacies nationwide participate in the Script Care network. If you use a nonparticipating pharmacy, your benefits are reduced by 50% (except in a documented emergency). (Find a participating pharmacy)
  • If you take "maintenance" medications (for ongoing conditions like high blood pressure or cholesterol, for example), you can save money and time by using the mail-order feature.
  • Some drugs, such as over-the-counter medications, diet-control drugs, experimental drugs, etc., are not covered under the prescription drug plan. See the Script Care website for a complete list of covered drugs.
  • Under both the standard and the high-deductible PPO plans, generic drugs for the following chronic conditions are provided at no cost to the participant (no deductible, co-pays, or co-insurance); Anti-asthmatic (GPI:44), Blood pressure (GPI: 33, 34, 36, 37), Cholesterol (GPI: 39), Diabetic Medications (GPI: 27) and Proton Pump Inhibitors (GPI: 49).
  • Under both the standard and the high-deductible PPO plans, preventive care medications (generics and brands without generics), contraceptives, and immunizations mandated by the Affordable Care Act are available at no cost to the participant: ACA Medications and Immunizations.

Standard PPO plan prescription drug benefits

 

  If you choose... You pay...
Retail (30-day supply) Generic $10 plus 20% of the cost over
$50
  Formulary name brand $55 plus 20% of the cost over
$275
  Nonformulary name brand $80 plus 20% of the cost over
$400
 
Mail order (90-day supply) Generic

$25 plus 20% of the cost over
$125

  Formulary name brand $137.50 plus 20% of the cost over
$687.50
  Nonformulary name brand $200 plus 20% of the cost over
$1,000

 

Prescription drug benefits under the high-deductible PPO

There is no separate prescription drug benefit under the high-deductible PPO. You will receive a prescription discount card, and if you open an HSA, you may use it to reimburse yourself for prescription expenses.

 

Before you reach your annual deductible... After you reach your annual deductible...
...you pay 100% of the cost of your prescriptions (less discount). ...the plan pays 80% of prescription costs and you pay 20% (less discount).

 

Want to know more?