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Prescription Costs

The cost of your prescription medication depends on the plan your employer offers. The tables below show the costs for each plan.

See below for definitions of the terms used in the tables.

Express Scripts Standard Plan

 
Retail
Home Delivery
2018
2018
Generic copayment
Up to $10
Up to $25
Preferred Brand-Name
copayment
Up to $40
Up to $100
Non-preferred Brand-Name and Brand Non-Sedating Antihistamines copayment
Up to $80
Up to $200
Dispensing Limits Per
Copayment
Up to 30-
day supply
Up to 90-
day supply

Express Scripts Premium Plan

 
Retail
Home Delivery
2018
2018
Generic copayment
Up to $5
Up to $12
Preferred Brand-Name
copayment
Up to $30
Up to $75
Non-preferred Brand-Name and Brand Non-Sedating Antihistamines copayment
Up to $60
Up to $150
Dispensing Limits Per
Copayment
Up to 30-
day supply
Up to 90-
day supply

*Deductible is for Brand-Name medications

CDHP/HSA

 
Retail and Home Delivery
Prescription Drugs
Annual Prescription Deductible
Combined with Medical Deductible
Generic
15% after deductible
Preferred Brand-Name Drugs (designated by Express Scripts
25% after deductible
Brand-Name Drugs Not on Express Scripts Preferred and Brand Non-Sedating Antihistamines
50% after deductible

These charts provide a general description and are provided for informational purposes only. They should not be viewed as an offer of coverage. In the event of a conflict between these charts and the official Plan documents, the official Plan documents will govern. 

Drug Categories

Generic - medications with the same active ingredients and manufactured according to the same strict federal regulations as their brand-name counterparts.

Brand-Name - a drug patented by the manufacturer and sold by its brand name.

Preferred  - generic and brand-name drugs that are preferred by your plan because they help to control rising prescription drug costs.

Non-preferred - generic and brand-name drugs that are not included on your plan's preferred list. They may be covered, but you may be required to pay a higher cost.

 

Health benefits are offered through plans maintained by Church Pension Group Services Corporation (doing business as The Episcopal Church Medical Trust), 19 East 34th Street, New York, NY 10016.

The Episcopal Church Medical Trust Disclaimer