UT Benefits for Emplyees
UT SELECT Prescription Drug Plan
Your prescription drug benefits under UT SELECT are administered by Express Scripts and require a $100 annual deductible per plan participant, per plan year.
UT SELECT Pharmacy Benefits
(does not apply to medical plan deductible)
||Generic Drug Copayment
||Preferred Drug Copayment
||Non-Preferred Drug Copayment
|Retail Network Pharmacy:
Up to a 30-day supply. Refills allowed as prescribed. (good option for new prescriptions)
|Home Delivery Pharmacy:
Up to a 90-day supply. Refills allowed as prescribed.
(best option for maintenance medication)
If you purchase a preferred or non-preferred drug when a less expensive generic alternative drug is available, you must pay the difference between the cost of the brand name drug and the generic drug plus the applicable generic copayment. This difference does NOT count toward your annual deductible. Sometimes the cost difference is quite large. Below is an example of how this type of claim would process if you had already met your $100 annual deductible:
$150 Cost of Brand Name Drug
-$55 Less Cost of Generic Equivalent
+$10 Plus Cost of Generic Copayment
$105 Your Payment
The generic, preferred, or non-preferred list of covered drugs is reviewed periodically resulting in changes to the prescription drug list throughout the year. If you are taking a medication that is affected by one of these changes, Express Scripts will mail a letter to your address on file to alert you of the change in benefits. Please refer to the Express Scripts website at www.expressscripts.com/ut or call Express Scripts Customer Service (1-800-818-0155) for current information on specific medications.
Specialty Pharmacy (Accredo)
Express Scripts provides specialty pharmacy services for patients with certain complex and chronic conditions through its wholly owned subsidiary, Accredo Health Group, Inc. (Accredo), with locations throughout the United States.
Specialty medications are drugs that are used to treat complex conditions, such as cancer, growth hormone deficiency, hemophilia, hepatitis C, immune deficiency, multiple sclerosis, and rheumatoid arthritis. Whether they’re administered by a health care professional, self-injected, or taken by mouth, specialty medications require an enhanced level of service.
You can obtain drugs designated by Express Scripts as specialty drugs using either your retail or mail-order benefit. You will be responsible for paying the corresponding mail-order or retail pharmacy copayment. If you choose to receive specialty drugs from a mail-order pharmacy, you must use Accredo as your pharmacy. The exception to this would be for certain products that are available through only one or two U.S. pharmacies. For those products, you will be directed to a pharmacy that can fill your prescription.
Your Prescription Drug Plan and Medicare Part D
The Federal Medicare program provides a Medicare-approved prescription drug benefit – Medicare Part D. The University of Texas System continues to offer your current UT SELECT prescription drug benefit, and enrollment in Medicare Part D will have a negative financial impact for most UT participants.
UT strongly urges you NOT to enroll in the Medicare Part D program. UT is committed to providing your prescription drug coverage now and in the future and to helping you make informed choices about your prescription drug benefit. For a relatively small number of very low-income UT retirees, enrolling in Medicare Part D may save money if the retiree also qualifies for a “low income subsidy” provided as part of the Medicaid Part D Program. Please see the Medicare Part D Notice of Creditable Coverage in the Legal Notices section of this handbook. For more information about the low income subsidy, call 1-800-772-1213 or visit www.socialsecurity.gov.