Express Scripts SaveOnSP Program
Beginning January 1, 2022, Express Scripts, our pharmacy vendor, has partnered with SaveOnSP to offer a prescription drug program designed to reduce copays for certain specialty medications. Through this new program, you may be eligible to receive your specialty medications free of charge. If your medication is included on the Duke 2022 SaveOnSP Drug List, Express Scripts will be reaching out to enroll you and your eligible family members in this program. It will be important that you enroll quickly so that you may enjoy a $0 copay for these medications in 2022. You will receive a letter from Express Scripts mailed to your home address on file that will include instructions on how to enroll.
Express Scripts 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, Duke Raleigh Hospital Plaza Pharmacy, Duke Regional Hospital Outpatient Pharmacy, and North Pavilion Retail Pharmacy).
Specialty medications must be purchased through Accredo® or the 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 you 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 on-site Duke Pharmacies except for Duke Basic participants. |
$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 on-site Duke Pharmacies except for Duke Basic participants. |
$70 | 50%** Min. $85, Max. $180 |
$180 |
** Duke Basic participants are required to use the mail order or on-site 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.
Participants in Duke Select, Blue Care and Duke Options have an annual $100 deductible per person that applies to short-term brand and non-formulary prescriptions filled at retail pharmacies and on-site Duke pharmacies.
Certain contraceptive drugs are covered at no cost to the member. More information is available at the Pharmacy Benefits website.
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.
Certain specialty pharmacy drugs are considered non-essential health benefits under the plan, and the cost of these drugs will not be applied toward a member's out of pocket maximum. Although the cost of these eligible specialty drugs will not be applied towards the out of pocket maximum, these costs will be reimbursed by the manufacturer at no cost to the member.