Prescription Drug Benefit

Overview

Your prescription drug benefits are administered by Express Scripts Pharmacy Benefit Services, a part of Evernorth Health Services. The prescription drugs covered are the same for all the medical plans and the copay or coinsurance amounts are the same for all the plans except for the HDHP option. 

Prescription drugs are categorized by tier. Tier One is primarily generic drugs; Tier Two is primarily preferred brand name drugs; and Tier Three is primarily non-preferred brand name drugs.

If your provider prescribes a brand-name drug and indicates “DAW” (or dispense as written)
when a generic alternative is available, you will pay the generic copay plus the difference in cost between the brand-name and generic drug. Under all the medical plan options, any additional cost you pay for receiving a brand drug when a generic is available will not apply to your out-of- pocket maximum and, under the HDHP, to your deductible.

With the HDHP, certain generic preventive drugs are subject to the coinsurance percentage reflected below but are not subject to the HDHP deductible. For all other prescription drugs, you must pay the full negotiated cost of the drug until your HDHP deductible is satisfied; then, coinsurance applies.

Co-Payments/ Co-Insurance	All health plans except HDHP	All health plans except HDHP	HDHP	HDHP
	30-Day Retail	90-Day Mail-Order, CVS or Walgreens	30-Day Retail	90-Day Mail-Order, CVS or Walgreens
Tier 1 (Generic)	$12*	$30*	20% co-insurance after deductible	20% co-insurance after deductible
Tier 2 (Preferred Brand)**	25% $50 min – $100 max	25% $125 min – $250 max	25% co-insurance after deductible ($100 max)	25% co-insurance after deductible ($150 max)
Tier 3 (Non-preferred Brand)	50% $75 min – $150 max	50% $187.50 min – $375 max	50% co-insurance after deductible ($150 max)	50% co-insurance after deductible ($225 max)
Specialty Drugs***	Generic – $12 per 30-day supply; $24 per 60-day supply; $36 per 90-day supply Brand – $125 per 30-day supply; $250 per 60-day supply; $375 per 90-day supply	Generic – $12 per 30-day supply; $24 per 60-day supply; $36 per 90-day supply Brand – $100 per 30-day supply; $250 per 60-day supply; $375 per 90-day supply	20% co-insurance after deductible	20% co-insurance after deductible
Out-of-Pocket Maximum	$2,500 – Individual; $5,000 – Family	$2,500 – Individual; $5,000 – Family	HDHP Out-of-Pocket Maximum applies	HDHP Out-of-Pocket Maximum applies

*For generic drugs used to treat diabetes and heart disease drugs for high cholesterol and hypertension only, the co-pay is $4 retail, $10 mail-order.

**Certain insulin products will have copay caps: a maximum of $25 for a 30-day supply and a maximum of $75 for a mail-order 90-day supply.

***Specialty drugs must be provided through the Express-Scripts specialty pharmacy, Accredo.

30-Day Retail Pharmacy

For short-term prescriptions, use a retail pharmacy. As an Express Scripts member, you can go to any of over 50,000 retail pharmacies, including most major drugstores. To locate a participating Express Scripts pharmacy, log on to Express-scripts.com and select “Locate a Pharmacy” under the Manage Prescriptions menu, or call Express Scripts at 1-877-880-1877.

Maintenance Medications

If you take a long-term maintenance medication, 90-day fills will be required after the first three 30-day fills. You can easily get a 90-day supply through the convenience of home delivery with Express Scripts or at CVS or Walgreens. If you do not switch to a 90-day supply after three 30-day fills, you will pay the full cost of the medication. For a list of medications subject to the 90-day supply requirement, see the 90-day Drug List (PDF).

90-Day Home Delivery Pharmacy

Home delivery is a great way to save money and it’s convenient too! Home delivery of medications is for members who take medicine on an ongoing basis. Express Scripts Home Delivery pharmacy sends you the medicine you need, right to your door, with free shipping and access to pharmacists for drug questions and more.

Setting Up Home Delivery

Starting home delivery is easy, ask your doctor to send your prescription electronically via ePrescribe to the Express Scripts Home Delivery pharmacy. Or you can start by calling Express Scripts at the number on the back of your member ID card (1-877-880-1877) and let Express Scripts contact your doctor for you. Note: You will need to provide Express Scripts with your delivery address and method of payment either by speaking with member services or logging in at Express-Scripts.com.

Transferring a Current Prescription to Home Delivery

Switching to home delivery is easy too! If you have existing maintenance prescriptions that are eligible, you can request to have them transferred from a retail pharmacy and delivered to you through the home delivery pharmacy. To review your home delivery opportunities, go to Express-scripts.com and either register as a new user or sign in. Review your prescriptions available for refill. Any medication that is displayed with the “Transfer to Home Delivery” option can be selected and then click “Add to Cart.” After you add your retail medication to the cart, you will need to go through the checkout process to finalize the transfer to home delivery. Express Scripts will then reach out to your doctor to receive their approval.

Estimating your Prescription Drug Co-pay

To determine what your co-pay will be for a prescription drug under either the retail pharmacy or mail order program, log on to Express-scripts.com and then select “Price a Medication” under the Manage Prescriptions menu. If you are not yet enrolled in a WashU health plan or are thinking of changing to/from the High Deductible Health Plan (HDHP) during Open Enrollment, log on to Express Scripts’ Open Enrollment website at Express-scripts.com/wustl to price a medication:

• On the welcome page, select “Open Enrollment Information”
• On the next page, select “WUSTL Actives” if you are enrolling in any WashU health plan other than the HDHP or select “WUSTL HDHP” if you are enrolling in the High Deductible Health Plan
• On the following page, select “Compare prescription medication costs”
• On the Price a Medication page, enter the name of your medication and follow the prompts thereafter to obtain your cost for a 30-day retail or 90-day mail-order supply of your medication

Wegovy and Zepbound GLP-1 Coverage

Wegovy and Zepbound, which are GLP-1 medications used in treating conditions including or
related to weight loss, are not covered under the prescription drug program through Express
Scripts. Instead, the university provides a health reimbursement arrangement offering a tax-free $350 contribution per member per month to an electronic debit card that you and/or your covered dependents can register for through RxSaveCard. You (or your covered dependent) will then need to purchase Wegovy or Zepbound through the manufacturer’s direct pharmacy (NovoCare for Wegovy and LillyDirect for Zepbound) and use the RxSaveCard debit card for payment. Like other drugs that are not covered under the prescription drug program, your out-of-pocket cost for Wegovy or Zepbound will not apply to the deductible or out-of-pocket maximum.

For additional information, including step-by-step instructions for registering for an RxSaveCard debit card and filling your prescription through NovoCare or LillyDirect, view the “RxSaveCard Program for Wegovy and Zepbound (PDF)” brochure. For commonly asked questions, please review our FAQ document.

Specialty Medications

For specialty medications (high-cost infused, injectable or oral drugs that are used to treat rare or complex conditions such as cancer, hemophilia, multiple sclerosis and rheumatoid arthritis), contact Accredo, Express Scripts’ specialty pharmacy, at 1-844-818-8978. Certain specialty medications may be limited to a 30-day supply.

SaveOnSP

Washington University participates in this Express Scripts program to help plan members, excluding those enrolled in the HDHP option, manage the cost of certain specialty drug medications. Members with an eligible prescription will be directed to SaveOnSP to enroll in the copay assistance program. For more information, call 1-800-683-1074.

*Note: Per IRS rules, High Deductible Plan Participants are not eligible for this program.

Washington University SaveOnSP Drug List

ID Cards

To request a replacement Express Scripts ID card or Print a temporary ID card, if you are already enrolled in a WashU health plan:

1. Log on to Express-scripts.com.
2. If you are already registered on express-scripts.com, enter your username and password to log on.
3. If you are not yet registered on express-scripts.com, select “Create Online Account.”  To create your online account, you will need to enter your 12-digit Express Scripts member number, which you can obtain by calling Express Scripts Customer Services at 1-877-880-1877.
4. Once you are logged on to express-scripts.com, select “Print & Request Forms & Cards” under the Health and Benefits Information menu.

Forms & Documents

• RxSaveCard Program for Wegovy and Zepbound (PDF)
• HDHP 2026 Preventive Drug List (PDF)
• 90-day Drug List (PDF)
• Express Scripts Mail-Order Form (PDF)
• Express Scripts Claim Form (PDF)
• Express Scripts Plan Document (PDF)
• Notice of Creditable Coverage for Medicare–Eligible Participants (PDF)