What you need to know
The Health Savings Plan comes with comprehensive prescription drug coverage, including an enhanced prescription drug benefit.
Filling Your Prescriptions
You can fill short-term prescriptions (30 days or less) at a network pharmacy; to get medications you take regularly, you must use home delivery from Express Scripts® Pharmacy or a participating Smart90 Anywhere Retail Pharmacy.
Find a pharmacy:
- BCBSNM and UnitedHealthcare participants, click here (registration and log in to Express Scripts is required)
What You Pay
You’ll pay nothing for generic preventive medications included on the Express Scripts Consumer Directed Healthcare (CDH) Preventive Medications – Standard Plus Drug List.
For all other prescription drugs, you’ll pay 100% of the cost— but only until you meet your annual combined medical and prescription drugs deductible. At that point, the plan will begin to share costs with you, based on the type of medication prescribed (generic, formulary brand, or non-formulary brand), until you meet the out-of-pocket limit for the year.
Your medical and prescription drug costs combine and accumulate together toward one out-of-pocket limit. In addition, your family members’ expenses accumulate together to meet the Health Savings Plan’s overall family deductible and out-of-pocket limit amounts. You pay the full costs before plan cost sharing begins for any one family member.
Here’s what that looks like:
| Prescription Drug Deductible | Combined with medical deductible |
| Prescription Drug Out-of-Pocket Limit* | Combined with medical out-of-pocket limit |
| Retail Pharmacy (up to 30-day supply) or Accredo Home Delivery (most limited to 30-day supply) | |
|---|---|
| Generic / specialty generic | $0 for drugs on an expanded list of preventive medications All other generic drugs: 20% after deductible ($5 min / $10 max) |
| Preferred brand / specialty preferred brand | 30% after deductible ($30 min / $45 max) |
| Non-preferred brand name / specialty non-preferred brand | 40% after deductible ($50 min / $75 max) |
| Express Scripts Mail Order or Express Scripts Smart90 Anywhere** (90-day supply) | |
| Generic | $0 for drugs on an expanded list of preventive medications All other generic drugs: 20% after deductible ($12.50 min / $25 max) |
| Preferred brand | 30% after deductible ($75 min / $112.50 max) |
| Non-preferred brand name | 40% after deductible ($125 min / $187.50 max) |
* The cost of out-of-network prescription drugs purchased outside of the program is covered at 50% and does not apply toward the out-of-pocket maximum.
** Maintenance medications purchased outside of the Smart90 Anywhere participating pharmacy will be billed at the full cost after the first two months of refills. Remember to submit a 90-day script or request the 90-days from the pharmacy (if available). See Benefit Summaries for details.
The SaveOn drug discount program is not offered with the Health Savings Plan.
Contacts and Resources
Go to the Get to Know Our Benefit Providers page for details.
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