Making the most of the employee pharmacy benefit

Paying for prescription medications isn't always easy to figure out. That's why Iowa State's benefits team is offering a few midyear reminders to help employees make the most of their pharmacy plan. Many of these are summarized in a new document, Unexpected Pharmacy Costs?, on the benefits website.

Employees enrolled in either Wellmark's Blue HMO or Blue PPO medical plans automatically receive prescription drug coverage through Express Scripts. There is no prescription deductible to meet, but there are co-pays or coinsurance and prescription drug out-of-pocket annual maximums ($2,000 per employee or $4,000/household). And remember, the medical and pharmacy out-of-pocket maximums are separate.

Express Scripts' 2024 plan summary for Iowa State employees is now online. It outlines processes for filling a prescription or requesting reimbursement on an out-of-network purchase, spells out co-pay and out-of-pocket responsibilities and lists what is and isn't covered in the prescription drug plan for ISU employees.

For example, a category of drugs currently not covered is those intended for weight loss.

"We know weight loss medications are important to our faculty and staff, and we're monitoring coverage opportunities," said Ed Holland, ISU benefits director. This is one of many health plan considerations the Employee Benefits Advisory Committee keeps an eye on, he said.

Here are a few other strategies for holding down costs on prescriptions for routine medications:

  • Similar to preventive health services, the federal Affordable Care Act designates a set of preventive drugs that are 100% covered with no co-pay or deductible. The categories are: generic aspirin, bowel prep products, breast cancer primary prevention, contraceptives, oral fluorides for children, folic acid supplements, HIV pre-exposure prophylaxis, iron supplements, single-agent statins for heart disease prevention, tobacco cessation and routine vaccines.
  • Choose a 90-day supply option -- known as SMART 90 -- for maintenance medications when you can, available through home delivery from the Express Scripts pharmacy or the local pharmacy. Plan ahead because once you hit your third refill on a 30-day supply, out-of-pocket costs may jump.
  • Ask questions. Talk to your doctor or local pharmacist about lower price options, or call Express Scripts, 800-987-5248, to speak to a staff pharmacist.
  • Set up an account on Express Scripts' free app.

Additional help to pay for specialty medications

Specialty medications are drugs used to treat complex or chronic conditions such as multiple sclerosis, rheumatoid arthritis, cancer or hemophilia. While a very small percentage of health plan participants need them, these medications are expensive, often require special handling and most require preauthorization. To avoid paying full cost for these medications, employees should do two things: First, fill these prescriptions through the Accredo Specialty Pharmacy; call 1-800-803-2523 to start this process. Accredo's service also includes education resources, refill reminders and more.

Second, a new feature to Express Scripts' coverage this plan year is copay assistance for specialty medications. It's administered by SaveOnSP, and reduces the employee's copay on 300+ specialty medications, in some cases to $0. It does this by enrolling a participant in the drug manufacturer's copay assistance program (when it's available) to lower the cost for their medication. SaveOnSP contacts ISU employees by mail about their eligibility for the program, and the employee gives SaveOnSP permission to monitor their pharmacy account on behalf of Express Scripts. While the SaveOnSP copay assistance program is an optional service for specialty medications, opting out can result in significantly higher out-of-pocket costs.

Learn more about your benefits

For more information about your benefits, check out the Employee Benefits website. Contact the benefits team, 515-294-4800 or, with questions about your benefits.