2022 Pharmacy - Copay Plans
Pharmacy is included when you elect medical coverage. Express Scripts remains our pharmacy vendor. The formulary with Express Scripts can change yearly. To avoid paying full price, please review the 2022 Preferred Formulary and Formulary Exclusion List.
How Much You Pay for Prescription Drugs Depends on Four Factors
Search Prescription Medications, Compare Costs and See Plan Details
Visit the Express Scripts Pharmacy Tool to get information about your estimated medication costs, participating in-network pharmacies and other plan guidelines.
$25 Brand name diabetic medication list
Express scripts by mail - up to a 90 day supply
The mail-order prescription benefit can save you money on long-term prescriptions. You can order up to a 90-day supply for your mail-order copay, compared with the 30-day supply you typically get at retail, so you’ll need fewer refills and pay less over time. Read about the Express Scripts Extended Payment Program.
Express Scripts offers 3 convenient mail order options:
> Your physician may call your prescription into Express Scripts at 1-888-327-9791
> Your physician may fax your prescription into Express Scripts at 1-800-837-0959
> You or your physician may mail your prescription to Express Scripts: P.O. Box 14711 Lexington, KY 40512
*NOTE - Your medication will usually arrive within 8 days following Express Scripts receiving your order.
To promote good health and help prevent the need for costly care, eligible preventative medications are available at no cost before you've met the deductible. Brand-name diabetic medications will have a $25 copay, excluding test strips.
Please note that the document below is a comprehensive list of Express Scripts' Preventative medications and may contain some medications not covered under the plan. In order to see if a Preventive drug listed in this document is covered by the Plan, see if the drug is also listed in the Formulary Medication list (see below).
$25 Brand name diabetic medication list
Patient Protection and Affordable Care Act (PPACA) Preventive items and services drug list- Mohawk Specific
The Mohawk health plan offers certain preventative service benefits at no cost to you as part of the Patient Protection and Affordable Care Act (PPACA). For items on the list to be covered, you must have a prescription, even if it is an over-the-counter item.
PPACA Preventive items and services drug list - Mohawk Specific
Specialty drugs are generally high-cost drugs used to treat certain chronic conditions. Specialty drugs are typically used to treat chronic, complex conditions and require specialized handling and/or administration. They need patient training, frequent dosing adjustments and intensive clinical monitoring to ensure their safe use and positive results. Specialty drugs are dispensed from a limited or exclusive specialty pharmacy.
Mohawk is partnering with VIVIO to manage specialty medication prescriptions to better ensure that employees and covered family members who have prescriptions for specialty medications receive the right drug at the best price.
VIVIO fills specialty medication prescriptions through its specialty pharmacy partners, Walmart Specialty Pharmacy, HealthWarehouse, and others.
If you have a question about how VIVIO and specialty medications, please contact the VIVIO Concierge by phone at 800-470-4034 or via email at
Summary of Material Modification-VIVIO Specialty Medications Program
COVID-19 Over-the-Counter test kits
As part of your pharmacy benefits, the Plan covers Over-The-Counter (OTC) COVID-19 test kits. You are eligible to receive up to 8 tests every 30 days for each individual enrolled in the Plan. Visit an in-network pharmacy and present your combined health and pharmacy ID card when you check out for the $0 copay.
If you visit an out-of-network provider, you will need to submit a claim for reimbursement to Express Scripts, and the Plan will limit its reimbursement to $12 per test. Please visit www.express-scripts.com/covid-19/resource-center for additional information, including how to submit a claim for reimbursement to the Plan.
Save More with the Walmart $4 Generic Drug Program
Did you know that Mohawk employees can get 30-day eligible generic prescription drugs from Walmart’s $4 generic drug program for little or no out-of-pocket expense?
The Walmart benefit applies only to eligible $4 generic drugs. See the full list of Walmart's eligible generic drugs:
- Click Here - Walmart Eligible $4 Generic Drugs
- Or Visit www.walmart.com and search "$4 drug list"
Bring in your prescription to the nearest Walmart Pharmacy or ask your doctor to call in the prescription.
- If your prescription is on Walmart’s eligible $4 generic drug list, your cost is $4 before the deductible is met and $0 after the deductible is met.
- If it is not on the list, you will pay the retail generic or brand name cost.
Website and Mobile App
- Register online with Express Scripts to save money, track and maintain your prescriptions - and have them delivered right to you! Registration Instructions
- The "Price a Medication" tool allows you to compare the cost of a medication at retail and via mail. The "My Rx Choices" tool identifies lower-cost alternatives to your long-term medications.
- Order, track and maintain your prescriptions
- Express Scripts Pharmacy mobile app - another great pharmacy resource for you. See details to the right.
Important Information about Medicare Prescription Drug Coverage
The Medicare Part D notice has important information about enrolling in Medicare Part D, and avoiding a Medicare late enrollment penalty.
Medicare Part D – Prescription Drug Coverage
Medicare and You - Guide
Medicare and You - Guide to Kidney Dialysis and Transplant
Additional Links & Information
Formulary Exclusion List
Express Scripts Reimbursement Claim Form
Express Scripts Mail Order Form
Contact the Benefits Service Center or Express Scripts
For questions about your pharmacy benefits or to request a Pharmacy ID card, contact us at
Benefits Service Center 1-866-481-4922
Express Scripts: 1-877-887-2879 | www.express-scripts.com