It’s important to be aware of how your benefits work. This month, we look at the prescription drug plan’s exclusions.
You may know that Express Scripts (ES), Lehigh’s prescription drug insurance provider, uses a Preferred Drug Step Therapy Program to help manage the cost of prescription drug coverage.
You might be less familiar with ES’s list of drugs that they will not cover, also known as exclusions. Here’s a link to the 2017 Preferred Drug List Exclusions.
In most cases, if you fill a prescription for one of the drugs on the exclusions list, you will pay the full retail price. Make sure you familiarize yourself with those medications.
The following are also examples of drugs or other charges not covered under the Express Scripts prescription plan:
- Medications lawfully obtainable without a prescription — excluding insulin
- Devices or appliances (except for diabetic supplies) — support garments or other non-medicinal substances
- Administration charges for drugs or insulin
- Cosmetic drugs and medications used for cosmetic purposes (e.g., Rogaine [Minoxidil] for hair restoration and Retin-A for individuals over 19 years of age)
- Investigational or experimental drugs
- Unauthorized refills
- Vitamins and dietary supplements
- Non-insulin injectables
- Prescriptions covered without charge under Federal, State, or local programs including Worker’s Compensation
- Medications for eligible individuals confined to a rest home, nursing home, sanitarium, extended care facility, hospital, or similar entity.
For more information, visit the Express Scripts website.