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 (TAC) offers a prescription drug plan as part of your medical coverage.

Effective January 1, 2021, the TAC has partnered with RxBenefits~Express Scripts to provide prescription drug benefits to participants.  RxBenefits administers the prescription drug plan, providing customer assistance and other services.  Express Scripts provides prescription drugs to participants as the Pharmacy Benefit Manager (PBM).

Participants can contact RxBenefits member services at 1-800-334-8134 from 7 AM – 8 PM Central, Monday-Friday, or anytime at customercare@rxbenefits.com for information regarding your prescription drug benefits. Information is also available by registering at ExpressScripts.com where you can track your prescription benefits, locate pharmacies and compare prescription drug costs.

Who is eligible?

If you enroll in the Standard PPO plan, you're automatically enrolled in the RxBenefits~Express Scripts prescription drug plan.

If you enroll in the High Deductible PPO, you pay for your prescriptions out of your own pocket until you reach your combined medical and prescription drug annual deductible, after which your plan pays 80% of your prescription drug costs. You can reimburse yourself from your Health Savings Account (HSA) 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 Express Scripts formulary whenever possible because non-formulary name-brand drugs are the most expensive. Please visit ExpressScripts.com and create a log-in ID and password for a list of the generic equivalents to brand-name drugs or see the RxBenefits~Express Scripts 2022 National Preferred Formulary List and Exclusions.

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 and coinsurance expenses.
  • The prescription drug maximum out-of-pocket is separate from the medical annual out-of-pocket maximums.
     

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How the RxBenefits~Express Scripts prescription drug plan works



 

  • You must use a participating pharmacy—which shouldn't be a problem, because more than 60,000 pharmacies nationwide participate in the RxBenefits~Express Scripts network. (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. Visit ExpressScripts.com for a complete list of covered drugs.
  • Under the Standard PPO Plan, certain generic prescription for the treatment of asthma, high blood pressure, high cholesterol, diabetes and proton pump inhibitors are available at no charge.  Contact RxBenefits’s member services at 1-800-334-8134 for more information.
  • Under the High Deductible PPO plan, certain generic preventive prescription for the treatment of asthma, high blood pressure, high cholesterol and diabetes are available at no charge.
     

Standard PPO plan prescription drug benefits

 

If you choose...

You pay at in-network pharmacy...

Retail Pharmacy Coverage

(1-30 day supply)

Generic

20% Coinsurance ($10 Minimum)

 

Preferred Brand

20% Coinsurance ($55 Minimum)

 

Non-Preferred Brand

20% Coinsurance ($80 Minimum)

 

Retail Pharmacy Coverage

(31-60 day supply)

Generic

20% Coinsurance ($20 Minimum)

 

Preferred Brand

20% Coinsurance ($110 Minimum)

 

Non-Preferred Brand

20% Coinsurance ($160 Minimum)

 

Retail Pharmacy Coverage

(61-90 day supply)

Generic

20% Coinsurance ($30 Minimum)

 

Preferred Brand

20% Coinsurance ($165 Minimum)

 

Non-Preferred Brand

20% Coinsurance ($240 Minimum)

 

Mail Order Extended Supply

(31-90 day supply)

Generic

20% Coinsurance ($25 Minimum)

 

Preferred Brand

20% Coinsurance ($137.50 Minimum)

 

Non-Preferred Brand

20% Coinsurance ($200 Minimum)

 

Specialty Medications

(1-30 supply)

(through Accredo Specialty Pharmacy 1-800-803-2523)

Specialty Generic

20% Coinsurance ($10 Minimum)

 

Specialty Preferred Brand

20% Coinsurance ($55 Minimum)

 

Specialty Non-Preferred Brand

20% Coinsurance ($80 Minimum

High Deductible PPO plan prescription drug benefits

Under the High Deductible PPO, you have a combined medical and prescription drug benefit. If you open a Health Savings Account (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.

...the plan pays 80% of prescription costs and you pay 20%.

Additional information

Questions?  For further information, contact:

Marianela Morales, Group Health Benefits Specialist / Wellness Program Coordinator:  mmorales@txcumc.org, wellness@txcumc.org or 713-533-3723

Patricia Goforth-Rakes, Senior Benefits Specialist, Pensions and Retiree Health Benefits / Walking Program Coordinator: pgrakes@txcumc.org or 713-533-3702

Barbara Kilby, Manager, Group Health and Pension Benefits / HIPAA Privacy Officer:  bkilby@txcumc.org or 713-533-3703

Mark Hellums, Controller, Pension and Health Benefits:  mhellums@txcumc.org or 713-533-3725

 

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