Prescription Plan
All Company employees who elect medical coverage through the Cigna plan receive prescription drug coverage through Express Scripts for both retail and home delivery (mail order) pharmacy services.
- Most prescription drug expenses will count toward your out-of-pocket maximum.
- Your Express Scripts prescription ID card must be used when you obtain your prescriptions.
- You pay a flat co-pay for each prescription.
- Remember, you almost always save money with generics!
Prescription Drugs for $0 copay
- Generic Oral Contraceptives
- Vaccines (immunizations) to prevent certain illnesses in people of all ages.
Preventive Drug List for $0 copay
Over-the-Counter (OTCs) Drugs for $0 copay
Select OTCs are covered for $0 copay as noted on the Prescription Plan Overview. You will need a prescription from your physician that states “OTC” for it to be covered for $0 copay.
Prescription Plan Overview
| Express Scripts | In-Network Providers | Out-of-Network Providers |
|---|---|---|
| Retail Prescription Drugs | Participating Pharmacy | Non-Participating Pharmacies |
BRAND ONLY Rx Deductible per participant per calendar year2 |
$50 Individual | Not Covered |
Zero copay ($0)3 |
$0 | Not Covered |
Generic |
$10 | Not Covered |
Preferred Brand4 |
$45 | Not Covered |
Non-Preferred Brand4 |
$80 | Not Covered |
| Retail Prescription Drugs (90-day) | Participating Pharmacies | Non-Participating Pharmacies |
BRAND ONLY Rx Deductible per participant per calendar year2 |
$50 Individual | Not Covered |
Zero copay ($0)3 |
$0 | Not Covered |
Generic |
$25 | Not Covered |
Preferred Brand4 |
$135 | Not Covered |
Non-Preferred Brand4 |
$180 | Not Covered |
| Mail Order Prescription Drugs (90-day) | ESI Home Delivery | Non-Participating Pharmacies |
BRAND ONLY Rx Deductible per participant per calendar year2 |
$50 Individual | Not Covered |
Zero copay ($0)3 |
$0 | Not Covered |
Generic |
$25 | Not Covered |
Preferred Brand4 |
$135 | Not Covered |
Non-Preferred Brand4 |
$180 | Not Covered |
| Specialty Prescription Drugs (30-day) | Accredo Specialty Pharmacy | Non-Participating Pharmacies |
BRAND ONLY Rx Deductible per participant per calendar year2 |
$50 Individual | Not Covered |
Generic |
$100 | Not Covered |
Preferred Brand4 |
$150 | Not Covered |
Non-Preferred Brand4 |
$200 | Not Covered |
- Drugs purchased at non-participating pharmacies are not covered.
- On the Prescription Drug Program, there is a $50 per participant deductible on BRANDS ONLY per calendar year. Generics and Brand OTCs are not subject to the prescription drug deductible.
- Select OTCs are covered for $0 copay. This includes:
- Nasal Allergy Spray: Flonase® Allergy OTC, Nasacort® Allergy 24HR, and Rhinocort
- Non-sedating Antihistamines: Alavert, Allegra (fexofenadine), Claritin (loratadine), Xyzal Allergy 24 HR, Zyrtec (cetirizine) in all forms: (D”), chewable syrup
- Proton Pump Inhibitors: Nexium 24 HR, Prevacid 24 HR, Prilosec OTC, or Zegerid OTC
- Remember, in order to get the “Over-the-Counter” (OTC) for Zero Co-pay ($0), you must have a prescription from your physician, and it must state “OTC”.
- Dispense As Written (DAW). If a member or their physician requests a brand drug when a generic drug is available; then the member will have to pay the brand co-pay plus the difference in the cost between the brand drug and the generic drug. The DAW penalty does not accumulate towards the deductible or the out-of-pocket maximum. It continues to apply to the member even after the OOP (out-of-pocket) maximum is met.
Prescription Drug Plan Notes:
• Some drugs may be excluded from the Plan. Please refer to your Summary Plan Description for more information.
• Step Therapy: A patient can be required to try a lower cost prescription drug that treats a given condition before “stepping up” to a similar-acting, but more expensive drug.
• Specialty medications used to treat chronic disease such as Multiple Sclerosis, Hepatitis C, Cancer, etc. that are generally self-injected, inhaled or oral are limited to 30-day supply through Accredo Specialty pharmacy. All specialty pharmacy prescriptions must be dispensed by Accredo Specialty Pharmacy.
• Compound drugs are limited to $300 per script.
Contact Express Scripts
- Online: express-scripts.com
- Call: (855) 778-1497
-
Download the mobile app:
- Create an online account
- Locate a provider
- View your vison benefit
- Get your member ID card
- Access other discounts
ESI 2026 Standard Plus Generics Only Preventive Medications Drug List
Express Scripts Member Portal User Guide
