New Prescription Drug Program Administrator Express Scripts Now Active
HealthSelectSM Prescription Drug Program—for non-Medicare participants in HealthSelect of Texas® plans including:
- HealthSelectSM Out-of-State and
- Consumer Directed HealthSelectSM
HealthSelectSM Medicare Rx—for Medicare-enrolled participants in the:
- HealthSelectSM Medicare Advantage Plan and
- HealthSelectSM Secondary
As the programs’ administrator, Express Scripts manages the pharmacy networks, the lists of medications that are covered and the cost that each plan pays for those medications.
ERS determines the structure of the plans. This includes the drug copay structure and pharmacy deductible. The structure has not changed.
In all plans except Consumer Directed HealthSelect the:
- Tier 1 copay for generic drugs at an in-network retail pharmacy is $10.
- Tier 2 copay for preferred brand drugs is $35.
- Tier 3 copay for non-preferred brand drugs is $60.
In Consumer Directed HealthSelect, after participants meet the combined prescription drug and medical deductible, they pay 20% coinsurance for prescriptions from an in-network pharmacy.
In all plans, costs are higher if you use an out-of-network pharmacy.
Each year deductibles start over on Jan. 1. There is a $50 per person prescription drug deductible in:
- HealthSelect of Texas,
- HealthSelect Secondary,
- HealthSelect Out-of-State and
- HealthSelect Medicare Advantage.
In Consumer Directed HealthSelect, there is a combined prescription and medical deductible.
What does the change to Express Scripts mean for you?
Overall, the new contract with Express Scripts offers lower drug prices to the program. However, you may find you are paying a different price for a medication you are taking. That may be because the annual deductible reset or because your medication has changed copay tiers. ERS has already heard from participants whose prices are slightly higher and others who are paying less than they did before.
Actions for you:
- Find and carry the ID card that was mailed to your home in early January. If you cannot find it, you can download a digital ID card using the Express Scripts app or going to your plan’s website (links below). You can also print the card. If you would prefer to have another one sent in the mail, call your plan at the number below:
- HealthSelect Prescription Drug Program (non-Medicare): toll-free (800) 935-7189, TTY: 711
- HealthSelect Medicare Rx (enrolled in Medicare): toll-free (866) 264-4676 TTY: 711
- Let your pharmacy know that your prescription coverage has changed. Your pharmacy may already be aware of the change, but it’s a good idea to check. If your pharmacy tells you that your prescription coverage has ended, it is likely they do not have the information about the new plan.
- Register your account on the website or app so that you can follow claims and check medication prices.
- If you take a specialty medication, Accredo is your new specialty drug provider. Most prescriptions transferred automatically to Accredo. If you have questions, contact Accredo member services toll-free at (800) 455-8340.
- While the Express Scripts network includes most of the same pharmacies as in the previous network, there are a few pharmacies that are not in the Express Scripts network. You may have to switch to a pharmacy that is in their network to get the best price for your medication.
- Express Scripts may have different protocols to approve a medication. Your doctor may have to provide additional information or you may have to start with a different medication.
- If a drug you are currently taking is not on Express Scripts’ list of covered drugs or has a different protocol for coverage, you may be able to continue with that drug under the previous coverage for a short time. Learn more about continuation of coverage in your plan:
- HealthSelect Prescription Drug Program (non-Medicare)
- HealthSelect Medicare Rx (enrolled in Medicare)
Why does ERS change plan administrators?
State law requires ERS to go out for bid for new plan administrator contracts every several years. ERS staff spend much time and effort evaluating the bidders and recommending the one we think will best serve our entire membership, as well as the State of Texas, which pays most of the claims. Cost isn’t the only consideration when we evaluate bidders, but it’s an important one. We also look at provider networks, covered drug lists, customer service and information security, among other things.
The new contract with Express Scripts will save the plan almost $3 billion over six years. Those savings benefit both the state and plan members by helping keep premiums and out-of-pocket costs reasonable. Our health plans haven’t had significant increases in premiums or changes in plan structure in several years, despite rising health care costs nationwide. Rebidding contracts is one reason ERS has been able to maintain high-quality coverage at reasonable costs.