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Pharmacy Benefits

The Medical Trust offers a prescription drug benefit under the Medicare Part D Program. It is administered by Express Scripts and is called Express Scripts Medicare™ (PDP) for The Medical Trust. Retirees with other Medicare Part D coverage have the option of Medicare Supplement Health Plans without prescription drug benefits.1

Pharmacy Benefits

Express Scripts prescription benefits are available in both retail pharmacies and via home delivery for ongoing, refillable prescriptions. Members can realize savings:

  • By requesting generic drugs whenever possible. Their doctor can advise them whether a generic medication is appropriate.
  • By using home delivery for prescriptions needed for 90 days or longer.

Retail Pharmacies
More than 67,000 participating retail pharmacies offer discounts with the Express Scripts ID card. Participating pharmacy can be located at Express Scripts' website.

Home Delivery
Members can order up to a 90-day supply of certain medications at one time, usually at a significant cost savings, through Express Scripts’ home delivery service. One of the benefits of home delivery is automatic refills and reminders when the prescription is expiring.

Members can visit Express Scripts' website to price a medication, download the formulary, or find a participating retail pharmacy. For more information:

  • Call the Express Scripts Call Center at (866) 544-6963

To request reimbursement for Medicare Part D prescription drug costs, use the Medicare Part D Prescription Drug Claim Form.

Copayments

Each time members fill a prescription, they are responsible for a copayment. The price will depend upon the plan in which they are enrolled and the type of drug prescribed. By enrolling in the Express Scripts Medicare plan, they will pay the copays listed below even when they reach the Coverage Gap stage ("the donut hole").

Drug Category Comprehensive Plan Plus and Premium Plans
  Retail Retail Home Delivery Retail Retail Home Delivery
Dispensing limits per copayment Up to a 31-day supply 63-90 day supply Up to a 90-day supply Up to a 31-day supply 63-90 day supply Up to a 90-day supply
Generic copayment $10 $30 $25 $5 $15 $12
Formulary brand-name copayment $30 $90 $70 $25 $75 $60
Non-formulary brand-name and all non-sedating antihistamines $50 $150 $120 $40 $120 $100
             

Deductible

There is no deductible with the Express Scripts Medicare plan.  

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.

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

Non-formulary - 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.

1To choose a Medicare Supplement Health Plan without pharmacy benefits, members must be enrolled in Medicare Part D. 

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

Unless otherwise noted, websites referenced herein that are outside the www.cpg.org domain are not associated with The Church Pension Fund and its affiliates (collectively, the Church Pension Group) and the Church Pension Group is not responsible for the content of any such websites.

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