Express Scripts, a national pharmacy benefit manager, provides pharmacy benefits for all four medical plans. Co-pays and deductibles vary depending on where you purchase your medications and the type of medicine prescribed (generic, brand or non-formulary).
Specialty medications must be purchased through Accredo or Duke pharmacy to be eligible for coverage under the plan, unless it is for immediate need called "STAT" medications. See hr.duke.edu for a listing of "Specialty" medications.
Below is a chart that outlines how filling your recurring, long-term medications through the mail order program or participating on-site Duke pharmacies can save money.
Co-pay Structure
| At a participating retail pharmacy | Through the Express Scripts Mail Order Pharmacy or Participating on-site Duke Pharmacies | ||
|---|---|---|---|
| Up to a 34-day supply | 90-day supply | ||
| First three purchases of any medication | After the third purchase of a long-term medication | Anytime | |
| Generic No deductible except for participants covered by Duke Basic |
$15 (or cost of drug if less) |
50%** Cost of drug to max. $30 |
$25 (or cost of drug if less) |
| Brand $100 per person retail deductible applies. No deductible for 90-day supply through mail order or Duke Pharmacies except for Duke Basic participant |
$50 | 50%** Min. $70, Max. $165 |
$130 |
| Non-formulary $100 per person retail deductible applies. No deductible for 90-day supply through mail order or Duke Pharmacies except for Duke Basic participant |
$70 | 50%** Min. $85, Max. $180 |
$180 |
** Duke Basic participants are required to use mail order or Duke pharmacies for long-term medications.
Participants in the Duke Basic medical plan have a $100 deductible for all prescription drugs including generic and mail-order prescriptions. Duke Basic participants are required to use mail order or Duke Pharmacies for long-term medications.
Injectable fertility drugs are not reimbursed according to our standard pharmacy benefit. Only plans covering infertility services include coverage of these drugs, which must be prescribed by a Duke Fertility physician.
More information is available at the Infertility Benefits website.