Prescription Drug

Administered by Express Scripts, prescription drug coverage includes medically necessary drugs and medicines prescribed by your or your covered dependent’s doctor on an outpatient basis.

You’re automatically enrolled in prescription drug coverage if you are enrolled in the:

  • Point of Service (POS); or
  • Traditional Indemnity.

Review the Medical Expense Plan Summary Plan Description (SPD) for details.

If you enroll in a Health Maintenance Organization (HMO), prescription drug coverage is provided through the HMO. Contact your HMO for details. HMO contact information is listed on the back of your medical ID card (if you are enrolled) and on the Your Benefits Resources (YBR) website.

How Prescription Drug Coverage Works

You can fill prescriptions three ways:

  • At a participating retail pharmacy;
  • At a nonparticipating retail pharmacy; or
  • By mail order (through the Express Scripts Pharmacy).

To find a participating pharmacy, visit the Express Scripts website or call 1-800-336-5934, 24 hours a day, seven days a week, except on Thanksgiving and Christmas.

For Short-Term Prescriptions (Up to a 30-Day Supply)
You can fill short-term prescriptions (up to a 30-day supply) at a participating (or nonparticipating) retail pharmacy. However, your prescription drug copayment will double after the third time you receive up to a 30-day supply of a maintenance medication at an in-network retail pharmacy.

For example, if you are enrolled in the POS option and receiving a formulary drug for high blood pressure, you will pay a $60 copayment (2 x $30 = $60) for up to a 30-day supply the fourth time you try to fill the prescription at a retail pharmacy. If you use the Express Scripts Pharmacy to fill your prescription, you can get up to a 90-day supply for only $60. (See below for information about the Express Scripts Pharmacy.)

If You Use a Nonparticipating Retail Pharmacy

When you use a nonparticipating retail pharmacy to fill a prescription, you pay the entire cost at the time of purchase. You will then need to file a claim with Express Scripts to receive reimbursement for a percentage of the cost.

For Maintenance Medications (Up to a 90-Day Supply)
To fill prescriptions for any medications you or your covered dependents use on an ongoing basis, such as those used to treat high blood pressure or cholesterol, use the Express Scripts Pharmacy (the mail-order service). You can order up to a 90-day supply each time at a lower cost than three 30-day supplies at retail.

To get started using the mail-order feature, visit the Express Scripts website or call 1-800-336-5934, 24 hours a day, seven days a week, except on Thanksgiving and Christmas.

To Learn More About Your Pharmacy Benefits
Listen to this recording.


Contributions for prescription drug coverage are included with your medical coverage contributions. Your out-of-pocket costs vary depending on how you choose to fill your prescriptions. For instance, if you purchase a brand-name drug when a generic equivalent is available, you will pay the generic copayment, plus the difference in cost between the brand-name and generic drug.

Please note that deductibles and out-of-pocket maximums are in addition to any that you may be required to pay under your medical coverage option. For your specific costs, visit the YBR website.