Current Provider: Express Scripts
- Group Name and Rx Bin: WUSTLRX #003858
- Customer Service: 1-877-880-1877
Your prescription drug benefits are administered by Express Scripts.
With the exception of the High Deductible Health Plan (HDHP), 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. With the HDHP, you must pay the full negotiated cost of the drug until your HDHP deductible is satisfied; then, you pay a 20% co-insurance.
|Co-Payments/ Co-Insurance||All health plans except UnitedHealthcare HDHP||UnitedHealthcare HDHP|
|30-Day Retail||90-Day Mail-Order||30-Day Retail||90-Day Mail-Order|
|Tier 1 (Generic)||$12*||$30*||20% co-insurance after deductible|
|Tier 2 (Preferred Brand)**||25%
$40 min – $80 max
$100 min – $200 max
|Tier 3 (Non-preferred Brand)||50%
$60 min – $120 max
$150 min – $300 max
|Specialty Drugs***||Generic – $12 per 30-day supply
Brand – $100 per 30-day supply
|Out-of-Pocket Maximum||$2,500 – Individual; $5,000 – Family||HDHP Out-of-Pocket Maximum applies|
*For generic drugs used to treat diabetes and heart disease drugs for high cholesterol and hypertension only, co-pay is $4 retail, $10 mail-order.
**Effective 01/01/2020, 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.
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. Not only is home delivery more convenient, but it also saves you money! By switching to home delivery, you will receive a 3-month supply of drugs for less than it would cost you at a retail pharmacy.
New Prescription. 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 log in at Express-Scripts.com.
Transferring a Current Prescription. 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 www.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 in order to finalize the transfer to home delivery. Express Scripts will then reach out to your doctor to receive their approval.
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 WUSTL 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 WUSTL health plan other 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
For specialty medications (those 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 1-800-501-7210. Certain specialty medications may be limited to a 30-day supply.
To request a replacement Express Scripts ID card or Print a temporary ID card, if you are already enrolled in a WashU health plan:
- Log on the Express-scripts.com.
- If you are already registered on express-scripts.com, enter your user name and password to log on.
- 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.
- Once you are logged on to express-scripts.com, select “Print & Request Forms & Cards” under the Health and Benefits Information menu.