Prescription Drug Benefits

Non-Medicare Prescription Drug Benefits

Express Scripts (ESI) administers the GIC prescription drug benefit for non-Medicare health insurance products. Use your ESI ID card when filling prescriptions.

Prescription drug deductible

You pay an annual prescription drug deductible of $100/individual and $200/family, separate from your health plan deductible. Once you have paid your prescription drug deductible, your covered prescriptions are subject to a copay.

Avoid the Express Scripts Retail Refill Penalty!

If you or a family member is taking a long-term medication—such as for high cholesterol or high blood pressure—you will receive a letter from Express Scripts asking you to tell them how you wish to receive your future refills—by mail or at your local CVS pharmacy.

If you choose to have your medication delivered to your home, your copay is lower. You can still pick up your medication at your local CVS pharmacy, but you’ll pay a higher copay*.

Make sure you respond to that letter from Express Scripts before your third refill, or you will be charged a significant penalty.

*If you choose the Express Scripts Pharmacy or a CVSTM pharmacy, you will pay one mail order copay for a 90-day supply of medication. If you use a non-CVS pharmacy, you will pay one retail copay for a 30-day supply of medication.

Covered drugs may change each January and July, when ESI updates its drug formulary.

Medicare Prescription Drug Benefits

CVS Silverscript administers the prescription drug benefit for all GIC Medicare health insurance products. Your prescription drug benefit is called an Employer Group Waiver Plan (EGWP). It combines a standard Medicare Part D drug plan with additional coverage provided by the GIC.

Medicare Part D Prescription Drug Coverage

IMPORTANT

  • Do not enroll in a non-GIC Medicare Part D product. All GIC Medicare plans include Medicare Part D coverage. If you enroll in another Part D product, the Centers for Medicare and Medicaid Services will disenroll you from your GIC coverage. This means that you will lose your GIC health, behavioral health and prescription drug benefits.
  • A “Notice of Creditable Coverage” is located in your plan handbook. It provides proof that you have comparable or better coverage than Medicare Part D. If you should later enroll in an individual Medicare drug plan because of changed circumstances, you must show the Notice of Creditable Coverage to the Social Security Administration to avoid paying a penalty.
  • If you have extremely limited income and assets, contact the Social Security Administration to find out about subsidized Part D coverage.
  • If your adjusted gross income, as reported on your federal tax return, exceeds a certain amount, Social Security will impose a monthly additional fee called IRMAA (Income-Related Monthly Adjustment Amount). Visit medicare.gov for more information. Social Security will notify you if this applies to you.

Contact CVS SilverScript with questions about your specific medications.

Drug Copays

All GIC health plans feature a three-tier copay structure. The copayments vary depending on the drug dispensed. See tier structures below.

TIER 1

Lowest Copay

You pay the lowest copay.
Most generic drugs
fall into this tier.

TIER 2

Mid-Level Copay

You pay the mid-level copay.
Many brand name drugs
fall into this tier.

TIER 3

Highest Copay

You pay the highest copay.
This tier includes brand-name and generic drugs that don’t
fall into Tiers 1 or 2.

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