This program is administered by Express Scripts (ESI) who will issue you an ID card when you become eligible.
Most pharmacies participate in the program, which provides you and the Plan with discounted prices on most drugs.
You can fill up to a 30 day supply of short-term prescriptions such as antibiotics at your local ESI participating pharmacy. You can fill up to a 90 day supply of long-term prescriptions such as high blood pressure medication for one co-pay if you use the ESI mail order program. You can also fill a 90 day supply of most prescriptions at Walgreens pharmacies.
Please note that Medicare eligible participants (when Medicare is not their primary plan) are required to use the mail order program starting with the third fill of every prescription. The use of mail order is a requirement for these participants.
Drug Card Benefits
When you use your Express Scripts ID Card at a participating pharmacy, you will pay 100% of the medication's cost before you meet your deductible. After the calendar year Comprehensive Medical Benefit deductible is satisfied, you will pay a 20% coinsurance for covered medications. If you select a brand drug when your physician allows a generic, you will have to pay the difference. If you don't use the card or if you go to a nonparticipating pharmacy, you'll pay 100% of the cost and must mail in a claim form to Express Scripts for reimbursement.
Mail Service Program
This program provides long-term or maintenance prescription drugs to Plan participants at discounted prices.
The Plan's regular deductible and payment provisions don't apply to prescriptions filled by the mail-service pharmacy. Instead, you pay the following co-pays to Express Scripts each time you order up to a 90-day supply of your medication:
For a 90 day supply of: Your Copay Generic drugs $10 Preferred brand name drugs (when generic not available) $20 Non-preferred brand name drugs $35
There is also a mandatory mail order program for specialized medications such as high-cost injectable, infusion, intravenous, and certain oral medications. The specialty drug mail order program is administered by Accredo (a subsidiary of ESI). These drugs are prescribed for diseases such as multiple sclerosis, rheumatoid arthritis, etc.; they often require special handling and are very expensive, and they are not usually stocked in retail pharmacies. Patients MUST go through Accredo for all specialty drugs, regardless of where the drug will be administered (this includes drugs that will be administered in a doctor's office). Specialty drugs that are not procured through Accredo will not be covered under the LINECO medical plan.
Specialty Step Therapy Program
"Step therapy" is used to guide a patient with a chronic condition to a less costly medication (called a "step one" drug), if appropriate, before they try a more expensive drug (called a "step two" drug). The goal is to ensure that the patient receives an appropriate medication for his condition. Since an appropriate drug is not always the most costly, step therapy can also help reduce costs.
Express Scripts will mail affected participants more information about the Specialty Step Therapy Program.
Please note that LINECO requires many specialty drugs to be ordered through Accredo, the Express Scripts specialty pharmacy.
Prescriptions under Medicare
Participants for whom Medicare is their primary plan are automatically enrolled in the LINECO-sponsored Express Scripts Medicare® prescription drug plan (PDP) for LINECO, an insured group Part D plan. Express Scripts Medicare® PDP will provide you with information concerning your co-pays, covered and non-covered drugs, and instructions for using the mail-order and specialty pharmacies. They will also handle customer service, prior authorizations and appeals.
The Express Scripts Medicare PDP has been developed to mirror the LINECO active prescription drug program. However, because this is a Federal sponsored program, there may be some differences. If you are on a drug that requires any type of special approval, you will be notified by Express Scripts.
Please note: You can only have one Medicare Part D prescription plan. If you, or your covered family members, are enrolled in a Medicare Part D prescription plan other than LINECO's you will not be eligible for any prescription coverage with LINECO.