How the Plans Work (CDHP and PPO Plans Only)

Short-Term Prescriptions

For short-term prescriptions, you can fill your prescriptions through retail pharmacies. Find the nearest pharmacy by visiting express-scripts.com/teaminc or calling 855-778-1495

Long-Term Prescriptions

Maintenance drugs are drugs you take for long-term or chronic conditions, such as blood pressure medication. All TEAM medical plans offer savings when you get 90-day supplies of these medications.

You have two ways to get your prescriptions:

  • Take advantage of home delivery from the Express Scripts Pharmacy. Your medications will be delivered directly to you with free standard shipping. To get started, visit express-scripts.com/teaminc or call 855-778-1495.
  • Pick up your prescriptions at a nearby preferred pharmacy. Find one near you by visiting express-scripts.com/teaminc.

You’ll be allowed two 30-day fills of a maintenance medication from a retail pharmacy. After that, if you get a 30-day fill or use a non-preferred pharmacy, you’ll have to pay the full retail cost.

Here’s a step-by-step look at how the plans work.

Save Time and Money with 90-Day Fills

If you take maintenance medications, it pays to use the home delivery service or a preferred pharmacy.

CDHP

Step 1: Pay Toward Your Deductible

If you haven’t met your medical plan deductible, you pay the full retail cost of your prescription. You can use your HSA to help you pay.

Step 2: Share Costs With the Plan

Once you meet your medical deductible, you will share costs with the plan — using money from your HSA or wallet — until you meet the out-of-pocket maximum.

Step 3: The Plan Pays the Rest

If you reach your medical out-of-pocket maximum, the plan will pay 100% of your eligible medical and prescription drug expenses for the rest of the plan year.

PPO Plans

Step 1: Share Costs With the Plan

For the Basic PPO, you must meet a separate $100 prescription drug deductible. Then you pay copays for your prescriptions. With the Enhanced PPO, there’s no separate deductible to meet — you just pay copays.

Step 2: The Plan Pays the Rest

If you reach your medical out-of-pocket maximum, the plan will pay 100% of your eligible medical and prescription drug expenses for the rest of the plan year.

CDHP and PPO Prescription Drugs at a Glance

Here’s what you pay when you get a prescription filled.

CDHP Basic PPO Enhanced PPO
Retail (30-day supply) Home Delivery Service/Preferred Pharmacy
(90-day supply)
Retail (30-day supply) Home Delivery Service/Preferred Pharmacy
(90-day supply)
Retail (30-day supply) Home Delivery Service/Preferred Pharmacy
(90-day supply)
Prescription drug deductible Combined with medical:
$2,000 individual
$4,000 family
$100 None
Generic 20% after deductible $10 copay $20 copay $10 copay $20 copay
Formulary brand1 20% after deductible $40 copay $80 copay $40 copay $80 copay
Non-formulary brand 20% after deductible $60 copay $120 copay $60 copay $120 copay
Specialty 20% after deductible $250 copay $500 copay $250 copay $500 copay
Out-of-pocket maximum Combined with medical:
$3,500 individual
$7,000 family
Combined with medical:
$6,000 individual
$12,000 family
Combined with medical:
$3,500 individual
$10,500 family
  1. The formulary drug list is updated annually, and medications may be added or removed. Before you fill a prescription, view the list, download the app or talk with your pharmacist to be sure you are getting a formulary brand or a generic option, if available.

Kaiser HMO Prescription Drugs at a Glance (California Only)

Prescription drug benefits are provided by the HMO. Here’s what you pay when you need a prescription filled. For more details, visit kp.org or call 800‑464‑4000.

Kaiser HMO (California only)
Retail
(Up to 30-day supply)
Mail-Order
(Up to 100-day supply)
Prescription drug deductible None
Generic $10 copay $20 copay
Brand-name $20 copay $40 copay
Specialty 20% ($200 maximum) N/A
Out-of-pocket maximum Combined with medical:
$1,500 individual
$3,000 family

Two Simple Ways To Save Money

  1. Ask about generics. When your doctor prescribes a medication, find out if there’s a generic available. Generic drugs use the same active ingredients as brand-name equivalents but cost about 30–60% less. If there’s no generic available, check to see if the medication is on the preferred drug list.
  2. Shop around. Pharmacies charge different amounts for drugs, and the costs can vary widely. Use goodrx.com to get cost estimates before you fill your prescription.

Convenience @Work

With the Express Scripts mobile app*, managing your medications has never been easier!

You can compare drug prices, check the status of your order and search for information about drug interactions. Learn more and download the app.

*Available if enrolled in the CDHP or a PPO.