Human Resources: Benefits

Prescription Drug Card Plan

The Bowling Green State University Health Care Program includes a Prescription Drug Plan and starting January 1, 2011 this benefit is administered by Express Scripts.

Nationwide Coverage

The network of pharmacies include more than 50,000 retail pharmacies. Many chain-store pharmacies, as well as many smaller Ohio independent pharmacies, are included in this network. If you need information about network pharmacies in a certain city or state outside Ohio, you can contact Express Scripts Customer Care Representatives at 1-800-430-6446 or  http://www.express-scripts.com/ . 

Using your Express Scripts Card

When filling your prescription at a network pharmacy, you must show your Express Scripts prescription drug card. By showing the card, the pharmacist can submit the claim electronically to Express Scripts and your co-pay will be based on the discounted amount negotiated between BGSU and Express Scripts. Your identification number on your Express Scripts Card is your specific BGSU ID number. 

If you need a new card, please call Express Scripts's Customer Care line at 1-800-430-6446, or click here to print a temporary card.

Utilizing a Non-Network Pharmacy

If you choose a pharmacy that is non-network (not participating in the network system), you will still receive coverage for you prescriptions. However, you will be responsible for paying 100% of the retail prescription cost and must submit a claim form to Express Scripts for reimbursement. The reimbursement of your claim may be different when utilizing an out-of-network pharmacy because the reimbursement will be based on the network plan cost.

The prescription drug claim form for filing reimbursement of out-of- network pharmacy prescriptions is available from the Express Scripts web site. 

Traveling

As you plan for your time away form the area and your prescription needs, this is a time to utilize the Home Delivery Program with Express Scripts and receive up to a 90 day supply. The mail order form can be found and printed from http://www.express-scripts.com/ . Prescriptions can be mailed to anywhere in the United States.

If you are going to be out of the country, for a period for greater than 30 days, please visit with a benefits representative in the Office of Human Resources to pick up a Home Delivery Program form and to discuss your prescription needs at least 30 days before your date of departure.

As you pack for your travel, include your medications in your carry-on luggage so they are not lost or stolen. Prescription replacements are not covered by the Plan.

Eligibility for prescription coverage

Employees

If you are a regular, full time employee eligible for coverage under the BGSU Health Care Program and elect to participate in in the optional Medical Plan, you are also covered under the Prescription Drug Plan.

Dependents

The Prescription Drug Plan extends coverage to your eligible dependents if you elect employee plus one or family coverage under the Medical Plan.

Covered Medications and Supplies

The Prescription Drug Plan pays the ingredient cost plus the dispensing fees. You are required to make any copayments. The drugs and supplies covered under the Plan include:

• Federal legend drugs; 
• State restricted drugs; 
• Insulin and insulin needles and syringes by prescription only; and 
• Compounded medications. 

"Federal legend drugs" includes all drugs labeled "Caution: Federal law prohibits dispensing without a prescription." Any federal legend drug which is not specifically excluded would be considered a covered drug.

Medications and Supplies NOT Covered Under the Plan

The drugs and supplies not covered under the Prescription Drug Plan are:

• Non-federal legend drugs; 
• Over-the-counter drugs; 
• Investigational or experimental drugs; 
• Birth control pills or birth control devices of any sort (however, the BGSU Student Health Center offers contraceptives at a discounted rate);
• Infertility Drugs
• Viagra like prescriptions /testosterone
• Therapeutic devices or appliances; 
• Rogaine for cosmetic reasons; 
• Medication for which the cost is recoverable under any Workers' Compensation or Occupational Disease Law or any state or governmental agency, or medication furnished by any other drug or medical service for which no charge is made to a participant; 
• The administration of drugs; 
• Medications received on an inpatient basis; 
• Reusable or multi-use syringes and needles; 
• A prescription refill in excess of the number specified by the physician; 
• Any refill dispensed after one year from the date on which the original prescription order was written; and 
• Drugs which are not medically necessary for the care and treatment of a patient. 
• Vitamins - over the counter or prescription except for Prenatal Vitamins

Using the Prescription Drug Card

When you become a participant in the Medical Plan, you receive an Express Scripts prescription drug card and other information regarding Express Scripts Primary Drug list and the Express Scripts chain network pharmacies. Your prescription card must be used when getting a prescriptions at participating (network) Express Scripts pharmacy. A listing of participating (network) pharmacies is available at http://www.express-scripts.com/

Plan Highlights 

• There is no deductible for the Prescription drug Plan. 
• The prescription drug card allows you to purchase up to a 30-day dosage per prescription in the retail pharmacy 
• A 90-day dosage for maintenance drugs may also be purchased through the Home Delivery Program. The forms may be obtained via the Express Scripts web site. 

Your Copayment/Co-insurance

When you or your covered dependent need a prescription filled, simply show your Express Scripts card along with the doctor's prescription to the pharmacist. Your copayment for each prescription is:

Once your prescription is filled, you pay any required copayment and the pharmacist bills Express Scripts for the remaining charges that the Plan will pay.

You can reduce your out-of-pocket costs by asking your doctor to prescribe generic drugs whenever possible. A generic drug is identified by its chemical name rather than the usually more expensive brand name. Many name brand drugs have moved to generic availability.

Filing for Reimbursement

If you purchase your drugs versus using your prescription drug card or if you choose to purchase a covered drug from a non-Express Scripts network pharmacy, you must pay for the prescription in full and then file a claim for reimbursement through Express Scripts.  Express Scripts reimburses you for the amount which would have been paid to a network pharmacy if your Express Scripts card had been used or the non-participating pharmacist's charge minus your copayment for filling the prescription, whichever is less. Reimbursement forms are available from the Express Scripts web site.

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