There are many prescription programs in place to ensure you are getting the best use of your prescription benefits. Sometimes, there is a generic alternative that might save you money on your prescription, there may be a therapeutic alternative to treat the same condition for a lower cost, or manufacturers may offer rebates on certain brands.
Express Scripts and Blue Cross and Blue Shield of Texas (BCBSTX) – How They Work Together
Express Scripts administers the prescription drug part of the BCBSTX A&M Care plans. When you receive a prescription and fill it at a participating pharmacy, the pharmacy knows to bill Express Scripts when you provide your BCBS insurance card or Express Scripts ID card. The plan includes a $50-per-person annual deductible (with a 3-person maximum). This deductible applies to the first $50 in prescription drugs that each covered person buys, whether at a retail pharmacy or through mail order. After you meet the deductible, you pay the applicable copayments for any remaining eligible drug purchases through the end of the plan year. Some of the prescription programs listed below assist with the amount of those copayments.
Express Scripts has a mandatory drug substitution policy. This means, when you are prescribed a brand name drug by your physician, and a generic substitute is available, you’ll automatically be given the generic version. You may choose to request the brand-name drug, but you will pay the difference in cost between the generic and brand-name drug as well was the brand-name formulary or non-formulary copayment. If you cannot take the generic drug for a documented medical reason, your doctor can call Express Scripts to request a medical override for the brand-name drug. If this is approved, you will receive the brand-name drug and will pay only the formulary or non-formulary brand-name copayment. This must be done in advance of the prescription being ordered and filled.
Prescription Care Management (PCM)
In addition to our prescription benefit plan, the Prescription Savings Program by PCM is a program that works with employees/retirees and covered dependents, their doctors and pharmacies to save the member money on prescription drugs. PCM offers you a choice to switch from higher cost drugs to a lower cost, equally-effective therapeutic alternatives. As a plan participant, no action is required unless PCM contacts you. PCM will contact your physician first to ask if the alternative will work with your medical history and for approval to make the change. If approved, then PCM will contact you for your permission to change medications. PCM will answer your questions and take care of the work involved to change your prescription at the pharmacy. This program does not change the pharmacy benefits offered by the A&M System and administered by Express Scripts. Should you receive a call from PCM, contact their member services department at 1-800-281-7050 with any questions or concerns.
SaveOn SP is an Express Scripts program that lowers the cost of a number of specialty drugs for both the members and the plan by taking advantage of manufacturer assistance programs. The specialty drugs are in specific medication categories such as Hepatitis C, Multiple Sclerosis, Oncology, Rheumatoid Arthritis, and a few others. If you participate in this program, you will have a zero cost for certain specialty medications. Your prescriptions will still be filled through Accredo, your existing specialty mail pharmacy.
- The cost of these drugs will not count towards the annual out-of-pocket maximum, and
- All plan members must use the Accredo specialty pharmacy for all specialty fills.
SaveOn is not available to the 65 Plus plan. If you have any questions or concerns, please contact SaveonSP at 1-800-683-1074 Monday – Thursday 7:00 a.m. – 7:00 p.m. Central and Friday 7:00 a.m. – 5:00 p.m. Central.