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 2020 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.
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. 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).
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.
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. How does the plan cover these drugs?
- In-network retail (30-day supply) - you pay 100% of the cost until you meet the appropriate deductible and then 20% of cost for $1-$999.99 or $100 per specialty prescription on those over $1,000.
- Mail order (90-day supply) - you pay 100% of the cost until you meet the appropriate deductible and then 20% of cost for $1-$999.99 or $100 per specialty prescription on those over $1,000.
- $100 co-pay qualified specialty medications for 30-day supply ($300 for 90-day supply).
- Some specialty medications are not covered on the Express Scripts drug list (see Specialty Drug Exclusion List below). In most cases, if you fill a prescription for one of these drugs, you will pay the full retail price. If you’re currently using one of the excluded medications, please discuss with your doctor about changing to one of the preferred alternatives.
The Mohawk Health Plan uses Tria regarding prescription fills for two specific conditions: Hepatitis C and Inflammatory Conditions such as Rheumatoid Arthritis.
If you currently receive your prescriptions from Express Scripts, you will continue to use them as your pharmacy provider. If you are a new user or new to these therapies, you need to contact Tria at 877-750-9355 to have your prescription filled.
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.
Additional Links & Information
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