Learn more about the prescription drug plan

Your 2017 prescription drug benefits (Health Fund and PPO 800)

When you enroll in either the Health Fund or the PPO 800 medical plan option, your prescription drug benefits are provided through Express Scripts. Here are some important things to know about your how your prescriptions are covered.

What’s covered

Dell’s prescription drug plan has a generic-based formulary. This means that generics are the preferred plan drugs. In situations when a generic is not available for a drug class, at least one brand name drug will be on the formulary. Generics are considered Tier 1 and formulary brand-name drugs are Tier 2 drugs. There are no benefits for Tier 3 drugs under this plan. If you decide to use a brand-name medication that is not listed on the formulary, you will be responsible for the full cost of the drug.

Why is Dell using a generics-based formulary? We are working with Express Scripts to control the rising cost of prescription drugs. We want to make sure you have access to safe, effective prescription drugs at affordable prices. Since generics are clinically equivalent to their more expensive brand name counterparts, it makes sense to base the formulary around them. For the classes of drugs that do not have a generic alternative, at least one brand name drug will be covered. A team of independent, licensed physicians, along with licensed pharmacists at Express Scripts, regularly reviews the latest research to decide which drugs to include on the formulary. They consider the safety and effectiveness of drugs available to treat various health conditions. When there are many different drugs available with similar safety and effectiveness, affordability is taken into account. Learn more about how the formulary is determined.

Review the Express Scripts formulary FAQ

Check if your prescription is on the Express Scripts formulary

Use in-network pharmacies

If you fill a prescription using an out-of-network pharmacy, you must pay 100 percent of the prescription price at the point of service. You may submit a completed claim form to Express Scripts, along with your prescription receipts for covered medications, for reimbursement of the amount the plan would have paid at an in-network pharmacy. Find an in-network pharmacy at express-scripts.com or on Express Scripts’ mobile app.

Keep in mind, however, that all network pharmacies do not charge the same prices. If you’re enrolled in the Health Fund or PPO 800 plan, you can use Castlight to find the best prescription values near your home.

No coverage for compound and PPI drugs (such as Prilosec and Prevacid)

Dell’s prescription drug benefit through Express Scripts does not provide coverage for prescription proton pump inhibitors (PPIs), such as omeprazole (Prilosec®), lansoprazole (Prevacid®), pantoprazole (Protonix®), Aciphex®, Nexium®, Zegerid® and Dexilant®. Also, Express Scripts will not cover prescriptions for most compound medications (drugs that require a licensed pharmacist to combine, mix or alter the ingredients of a medication when filling a prescription). If you have questions, contact Express Scripts at 1-866-272-6695.

Preventive drugs

Certain preventive medications are covered before the deductible (for the Health Fund), or are free to you. See if your prescription is on the Express Scripts’ preventive drug list.

When certain over-the-counter medications (such as aspirin, fluoride, vitamin D and folic acid supplements) are covered at no cost to you, they will require a prescription and are subject to certain eligibility requirements (for example, folic acid supplements will only be covered at no cost for women between the ages of 18 and 45).

In compliance with health care reform, all types of female contraceptive methods approved by the FDA are available at no cost to women through age 50 when filled through Express Scripts.

Formulary exceptions

If you have already tried the generic and/or the formulary brand-name drugs and have found that they do not work for you, ask your doctor to contact Express Scripts at 1-800-417-8164 to provide documentation that supports your need for a non-formulary drug. Generally, you must have previously tried at least two alternatives (a generic and/or a lower-cost formulary brand-name drug) before a non-formulary drug will be approved. The formulary contains a wide variety of affordable drugs, and in most cases, your doctor will find a formulary drug that meets your needs. If a non-formulary drug is approved, you will pay the Tier 2 copay.

Home delivery for maintenance medications

Express Scripts’ home delivery service is a safe and convenient way to fill prescriptions you take on a long-term basis, and it saves both you and Dell money. Plus, it saves you a trip to your local pharmacy!

Home delivery is not required. However, if you don’t want to enroll and save with home delivery, you must tell Express Scripts by calling 1-800-481-4627; otherwise, you’ll pay the full cost of your medication if you try to refill it at a local participating pharmacy more than twice. You may also opt out of home delivery on express-scripts.com.

Meet with your health coach, save on certain prescriptions

The Well at Dell health improvement programs can help you and your spouse or domestic partner learn about, manage and improve your health. Participants are eligible for tobacco cessation, hypertension and diabetes medications at reduced or zero copays. To be eligible, you and/or your spouse or domestic partner must complete the health survey at the WebMD website (@ Work | Log in) and meet with a health coach every three to four months. Learn more about health goals.

Step therapy saves you and Dell money

If you take medication to treat certain conditions, Express Scripts works with you and your doctor to see if you should first try a less expensive, clinically effective brand or generic drug before trying the brand-name-only medication (a process called “step therapy”). Conditions include diabetes, high blood pressure, heart disease, osteoporosis, pain and inflammation, seizures, skin disorders and sleep disorders. See if your medication is included in the step therapy program.

Fill specialty drug prescriptions at Accredo

Specialty drugs are high-cost injectable, infused, oral or inhaled drugs that generally require special storage or handling. All specialty drugs must be filled exclusively through Accredo (Express Scripts’ specialty pharmacy), except for stat medications. For questions about prescriptions for specialty medications, call Accredo at 1-800-803-2523. Learn more.

Certain drugs require prior authorization

Prior authorization is a review process by Express Scripts that ensures certain medications are appropriate for specific conditions, based on Dell’s plan coverage guidelines. If you receive authorization for a covered drug, you’ll pay the applicable coinsurance. If your prescription isn’t covered or prior authorization isn’t received and you and your doctor decide that you should still take this drug, you will pay the full cost of the drug.

To find out if your prescription requires prior authorization, call Express Scripts at 1-866-272-6695.

For more information

See the summary plan descriptions on Your Benefits Resources website (@ Work | Log in). From Your Benefits Resources home page, go to the Knowledge Center.

Remember: If you have questions about your benefits, contact the Dell Benefits Center at 1-888-335-5663, option 1, option 1.

Paying for prescription drugs in the Health Fund

Your prescription medicines count toward your deductible*. Until you meet your Health Fund deductible, you pay the full cost of most prescriptions. After you meet your deductible, here is what you pay:

Tier 1 (generics)

  • Retail: $8 copay up to 34-day supply
  • Home delivery: $16 copay for 61 to 90-day supply

Tier 2 (formulary brand-name drugs)

  • Retail: You pay 30% of the cost ($40 minimum, $90 maximum) up to 34-day supply.
  • Home delivery: You pay 30% of the cost ($95 minimum, $215 maximum) for 61 to 90-day supply.

Non-formulary drugs are not covered.

If you decide to use a brand-name medication that is not listed on the formulary, you will be responsible for the full cost of the drug. Find out how to get an exception.

To see how your drug is covered, check the Express Scripts formulary. To price a medication visit Castlight or go to express-scripts.com.

*There’s no requirement to meet deductible for prescriptions on Express Scripts’ preventive drug list.

Paying for prescription drugs in the PPO 800 and Aetna Indemnity Plan

There’s no deductible to meet for prescription drugs, and the annual out-of-pocket maximum is $1,500. This is how the pricing works:

Tier 1 (generics)

  • Retail: $8 copay up to 34-day supply
  • Home delivery: $16 copay for 61 to 90-day supply

Tier 2 (formulary brand-name drugs)

  • Retail: You pay 30% of the cost ($40 minimum, $90 maximum) up to 34-day supply.
  • Home delivery: You pay 30% of the cost ($95 minimum, $215 maximum) for 61 to 90-day supply.

Non-formulary drugs are not covered.

If you decide to use a brand-name medication that is not listed on the formulary, you will be responsible for the full cost of the drug. Find out how to get an exception.

To see how your drug is covered, check the Express Scripts formulary. To price a medication visit Castlight or go to express-scripts.com.

Prescription drugs in the regional plans

If you live in areas served by other medical options (Aetna International, Harvard Pilgrim, Kaiser Permanente HMO (California only) or Kaiser Permanente POS (Hawaii only), please contact the specific health plan for details on prescription drug benefits.