2022 Pharmacy - HSA 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
1. Whether you buy from an In-network retail pharmacy, the mail-order program or Walmart
2. Whether your medications are on the Formulary List, Preventive List or Walmart $4 Generic List
3. The type of drug you are purchasing: Generic or Brand Name
4. $25 Brand name diabetic medication list - click to go to link
5. Whether you fill a 30 or 90 day supply
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.

pdf button $25 Brand name diabetic medication list

2021 Peach Line

Plan Details

pharmacy graphic 2022

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.

Preventive Prescriptions

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).

pdf button Preventive Medications List

pdf button Preferred Formulary

pdf button $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.

pdf button PPACA Preventive items and services drug list - Mohawk Specific

Specialty Drugs 

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 This email address is being protected from spambots. You need JavaScript enabled to view it. Concierge hours are Monday through Friday 8am-8pm ET and Saturday 10am-3pm ET.

pdf button Specialty Drug List

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:

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.

pdf button Medicare Part D – Prescription Drug Coverage
pdf_button Medicare and You - Guide
pdf_button Medicare and You - Guide to Kidney Dialysis and Transplant

2021 Peach Line

Additional Links & Information

pdf button Preferred Formulary
pdf button Formulary Exclusion List 
pdf button Express Scripts Reimbursement Claim Form
pdf button 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

Save

Save

Save

Save

Save

Save

Save

Save

Save

Save

Save

Save

Save

Save

Save

Cigna
1-855-566-4295
Express Scripts
1-877-887-2879
Amwell
1-844-733-3627
Metlife
1-855-488-0520
Aflac
1-800-433-3036
TaxSaver Plan
1-800-328-4337
Fidelity
1-800-835-5087
One America
1-855-279-6375
HLC
1-877-365-0051
Hodges-Mace / Alight
1-877-308-9157