Prescription Drug Plan

Administered by Prime Therapeutics

Prescription drug benefits are part of SMU's BCBSTX BlueChoice© PPO medical plans, but are administered by Prime Therapeutics. You have the choice of purchasing your Generic, Preferred Brand Name, and Non-Preferred Brand Name prescriptions through local retail pharmacies or through the Express Scripts home delivery service (mail order program). Specialty medications are only available through the home delivery service via Accredo specialty pharmacy. Please click on the tabs above to access additional information.

IMPORTANT: Be sure to log into myprime.com and register so that you have access to find in-network pharmacies, price medications, get forms, and keep track of your prescription medications.

    Resources

    Mail Order (90-Day Supply)

    Administered by Express Scripts
    (833) 715-0942
    www.express-scripts.com/rx

    The Express Scripts home delivery service should be used for prescription medications that you take on a regular basis (maintenance medications). You can order up to a 90-day supply of your maintenance medication(s). All home delivery medications will be mailed directly to your home, often at reduced cost to you. Using the home delivery service program is convenient because you can avoid trips to the pharmacy and get a 90-day supply at one time (for maintenance medications). If you have any questions regarding the home delivery service for any of your prescriptions, please call  833-715-0942.

    Important:  Prime Therapeutics PrimeMail is combined with Express Scripts Mail Service. Your PrimeMail prescription(s) are filled by Express Scripts. The mail service phone number  833-715-0942.

    You will see the Express Scripts name on your pill bottle(s) and pharmacy benefits communications. When it's time to refill a prescription, it will be refilled by Express Scripts. If you don't have refills, or if your prescription expires, ask your doctor to fax a new prescription to Express Scripts Mail Service at 888.327.9791.

    Mail Order (90-Day Supply) You Pay

    $2,000 Deductible PPO
    You must meet a $100 deductible each year for brand name medications; then, you pay the following amounts:

    Generic 30% of cost up to $20
    Preferred Brand Name 30% of cost up to $98
    Non-Preferred Brand Name 50% of cost

    $2,800 Deductible PPO
    You pay 100% of the cost until you have met the annual plan deductible; then, you pay the following amounts:

    Generic 30% of cost up to $20
    Preferred Brand Name 30% of cost up to $98
    Non-Preferred Brand Name 50% of cost

    $5,000 Deductible PPO
    You pay 100% of the cost until you have met the annual plan deductible; then, you pay the following amounts:

    Generic 0% of cost
    Preferred Brand Name 0% of cost
    Non-Preferred Brand Name 0% of cost

    Important Notice: Specialty Drugs are covered through the Retail service and the Prime Therapeutics Specialty Pharmacy Program (dispensed by Accredo). You will find additional information on the Specialty Pharmacy Program Tab above.

    Resources

    Retail (Up to 30-Day Supply)

    Administered by Prime Therapeutics
    www.myprime.com

    The retail prescription program utilizes a network of participating pharmacies. To receive the highest benefit level, you must use a participating pharmacy. Prescriptions filled at non-participating pharmacies are generally not covered.

    If you need to find an in-network pharmacy or price a specific medication, go to www.myprime.com and register as a new user if you have not yet registered. Click on Find Medicine or Find Pharmacy, as needed.

    Retail(30-Day Supply)

    $2,000 Deductible PPO
    You must meet a $100 deductible each year for brand name medications; then, you pay the following amounts:

    Generic 30% of cost
    Preferred Brand Name 30% of cost
    Non-Preferred Brand Name 50% of cost
    Specialty Medication 30% of cost up to $225 max per script

    $2,800 Deductible PPO
    You pay 100% of the cost until you have met the annual plan deductible; then, you pay the following amounts:

    Generic 30% of cost
    Preferred Brand Name 30% of cost
    Non-Preferred Brand Name 50% of cost
    Specialty Medication 30% of cost up to $225 max per script

    $5,000 Deductible PPO
    You pay 100% of the cost until you have met the annual plan deductible; then, you pay the following amounts:

    Generic 0% of cost
    Preferred Brand Name 0% of cost
    Non-Preferred Brand Name 0% of cost
    Specialty Medication 0% of cost

    Resources

    Specialty Pharmacy Program

    Administered by Accredo
    (833) 721-1619

    Specialty medications are only available through the home delivery service via Accredo specialty pharmacy. You can order up to a 90-day supply of your maintenance medication(s) and 30-day supply for specialty medications.

    Your prescription drug plan includes coverage for certain specialty medications. Specialty medications are generally high-cost injectable drugs with special handling or storage requirements that require careful adherence to treatment protocols. To assist members who require these medications, Prime Therapeutics includes a specialty pharmacy program to provide additional support. When you obtain covered specialty medication through the Accredo specialty pharmacy program, you receive — at no additional charge — services designed to help in managing your therapy, including:

    • Coordination of coverage between you, your physician, and Accredo.
    • Convenient delivery of medications through the home delivery service.
    • Educational materials, including information about managing potential medication side effects.
    • Syringes, “sharps containers”, and other supplies with every shipment for self-injectables.
    • 24/7/365 customer service phone access.

    To contact the Accredo Specialty Pharmacy Program, call (833) 721-1619.