Prescription drug benefits are included in the BJC Medical Plan option that you elect. Present your Cigna medical ID card when purchasing medications.
Prescription Drug Coverage Chart
| | BJC Pharmacies | Walgreens | BJC Employee Pharmacy
(Mail-Order only) |
| Up tp 30-Day-Supply
1st Fills Only (MO & IL) | 30-Day / 90-Day Supply
1st Fills & Refills
(MO & IL) |
| Generic Drugs | $10 | $25 | $10 / $25 |
| Preferred
Brand-Name Drugs | $30 | $75 | $30 / $75 |
| Non-Preferred
Brand-Name Drugs | $75 | $150 | $75 / $150 |
| Specialty Drugs | See details below. |
| Annual Out-of-Pocket Maximum |
| Per Individual | $2,000 |
| Per Family | $4,000 |
Copayments
Prescription drug copayments depend on the type of pharmacy you choose and the type of drug you purchase and the supply amount. Copayments for the above listed 90-day supplies apply only to maintenance medications.
Each BJC Medical Plan participant is allowed two emergency fills per calendar year (from a list of eligible drugs) at Walgreens, and at the same copayment as BJC pharmacies.
Key Features:
- Prescription drug claims are administered by Express Scripts
- You will pay the lowest copayment when filling NEW prescriptions (first fills) at any BJC pharmacy, including the BJC Employee Pharmacy (mail-order). New prescriptions filled at Walgreens will be subject to a higher copayment
- All REFILLS in Missouri and Illinois need to be filled through the BJC Employee Pharmacy (mail-order) to obtain the lowest possible copayment. Refills not processed through the BJC Employee Pharmacy (mail-order) will result in significantly higher costs to you
- All Specialty Drugs (first fills and refills) need to be directed to the BJC Employee Pharmacy (mail-order). Copayment is $50 if filled through the BJC Employee Pharmacy (mail-order) or $100 if filled through Walgreens
Eligible Pharmacies
- BJC Employee Pharmacy (mail-order) can deliver 30-day first fills (new prescriptions), refills and 90-day supplies of maintenance medications, and all specialty drug prescriptions with no mailing or handling fees. Employees should order 10 business days in advance (average delivery time may be shorter).
- BJC Pharmacies include six pharmacies that are located within BJC facilities, plus the BJC Employee Pharmacy (mail-order).
- Express Scripts Pharmacies are exclusively Walgreens. Walgreens operates 8,175 drugstores with a presence in all 50 states.
Types of Drugs
- Generic Drugs offer the same level of quality, safety, and effectiveness as their brand name equivalents; but at lower prices.
- Preferred Brand-Name Drugs cost more than generic but less than non-preferred brand name drugs; ask your doctor if a generic substitution is available.
- Non-Preferred Brand Name Drugs cost more than preferred brand-name drugs and are often used to treat complex medical conditions; ask your doctor if a generic or preferred brand-name “equivalent drug” is available.
- Specialty Drugs cost the most and can require special handling, administration or monitoring. They are used to treat complex and chronic conditions, such as multiple sclerosis, rheumatoid arthritis, hepatitis C and hemophilia. All Specialty Drug prescriptions must be directed to the BJC Employee Pharmacy mail order.
Details about prescription drug benefits, including mail-order service, how to fill prescriptions, BJC pharmacy locations, and prescription drug lists (emergency, maintenance, specialty, etc.) can be found at www.totalrewards.org/Benefits/Pharmacy.