Express Scripts, a national pharmacy benefit manager, provides pharmacy benefits for all four medical plans. Co-pays and deductibles vary depending on the type of medicine prescribed (generic, brand or non-formulary), the length of the prescriptions, and whether you purchase at a retail pharmacy, through the Express Scripts mail order pharmacy, or through participating on-site Duke Pharmacies (Duke Outpatient Pharmacy, Duke Children’s Health Center Retail Pharmacy, Campus Center Pharmacy at the Student Wellness Center, Duke Specialty Pharmacy at the Cancer Center, and Duke Raleigh Hospital Plaza Pharmacy).
Specialty medications must be purchased through Accredo®, the specialty pharmacy for Express Scripts, or Duke Specialty Pharmacy to be eligible for coverage under the plan, unless they are medications which are intended for an immediate need. See Pharmacy Benefits for a listing of “Specialty” medications.
Co-pay Structure
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.
| 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 Annual $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 Annual $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 the mail order or Duke Pharmacies for long-term medications.
Participants in the Duke Basic medical plan have a $100 annual deductible for all prescription drugs (except for certain contraceptive drugs) including generic and mail-order prescriptions. Duke Basic participants are required to use mail order or Duke Pharmacies for long-term medications.
Certain contraceptive drugs are covered at no cost to the member. More information is available at Pharmacy Benefits.
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.