Prescription drugs

Affordable, convenient options, with some free generics

compare_arrowsCOMPARE YOUR PRESCRIPTION PLAN OPTIONS

  • All medical plans include pharmacy coverage through Express Scripts, the Pharmacy Benefits Manager.
  • Express Scripts provides retail options at convenient retail locations all over town.
  • For long-term maintenance medications, the Smart90 Program allows you to receive a 90-day supply of your medication in two ways – either through the Express Scripts’ Mail Service Pharmacy (online, by phone, through mail or the free Express Scripts mobile app.) or at a Smart90 retail pharmacy near you. Smart90 retail locations are places like Costco, HEB, Randalls and Walmart.

  • Generics for high blood pressure and high cholesterol are free.
  • The plan does not cover prescriptions filled at non-participating pharmacies.
Retail prescriptions

For short-term prescriptions like antibiotics or pain medications, take your prescriptions and your ID card to any Express Scripts participating pharmacy. Once you meet your annual per-person prescription drug deductible, you pay a copay or coinsurance for each prescription. If the drug costs less than the copay or coinsurance, you pay the actual cost instead.

Maintenance prescriptions

For long-term, and maintenance medications, the Smart90 Program allows you to receive a 90-day supply of your medication in two ways – either through the Express Scripts' Mail Service Pharmacy (online, by phone or through mail) or at a Smart90 retail pharmacy. No matter which option you choose, your copay or coinsurance remains the same. You must obtain a 90-day prescription from your physician. 90-day maintenance prescriptions can be picked up locally at Costco, HEB, Kroger, Randalls, and Walmart or through Express Scripts’ Mail Service Pharmacy. Refer to www.express-scripts.com or call Express Scripts at 855-712-1403 for the most current network information.

When you have a new prescription for a long-term or maintenance medication, you can receive two 30 day courtesy fills at any Express Scripts participating retail pharmacy or through the Express Scripts’ Mail Service Pharmacy. After the 2nd fill, you will need to obtain a 90-day prescription for the long-term or maintenance medication that will need to be filled at a participating retail pharmacy or filled through Express Scripts’ Mail Service Pharmacy . If you continue to fill a 30 day supply at retail, you will pay the entire cost of the medication. Ordering a 90-day supply through Express Scripts’ Mail Service Pharmacy or a Smart90 retail pharmacy will result in substantial savings to you for long-term and maintenance medications.

Participating retail locations and home delivery forms are available on the Express Scripts website.

Note: CVS Caremark, Sam's Club and Walgreens are not on the 90-day prescription retail partner list.

No-cost prescriptions for high blood pressure and high cholesterol

90-day generic drugs for high blood pressure and high cholesterol are available at no cost to you as long as you're enrolled in an Aldine ISD medical plan.
 
The plan also covers women's generic contraceptives at 100%, as well as those that have no generic available.

An easy way to handle maintenance drug prescriptions

When you sign up for the automatic prescription refill program, Express Scripts’ mail service pharmacy automatically sends your refills and requests a new prescription from your doctor when a maintenance prescription is about to expire or the last refill has been used.

Specialty drug prescriptions

Specialty tiers are typically biotech drugs that are injectable, are in pill form or are administered by your doctor. Our plan covers two tiers of specialty drugs. Tier II are generics and/or preferred drugs. Tier III are non-preferred brand drugs, which have higher copays. For more information about specialty drug coverage, contact Accredo (Express Scripts specialty mail order pharmacy) or visit accredo.com.

Prior authorization

The prescription drug plan doesn't cover certain medicines without prior authorization for medical necessity. If you're currently using one of these drugs and don't get authorization from your doctor, you may have to pay the full cost of your medication. Another option is to choose a generic or brand formulary alternative from the Express Scripts standard formulary. When you choose a drug from this list, you don't have to get prior authorization.

Prescription drug list

The Express Scripts formulary (drug list) includes generic and brand-name drugs that our medical plan prefers for certain conditions. If you choose drugs that aren't on the list, you may be responsible for the full cost, which can be significantly higher. You can register on the Express Scripts website to see the preferred medications list for our plan, find the price of medications and determine if a medication has any special authorization requirements.

Important: If you or your physician request a brand-name drug when a generic is available, you pay the brand copay PLUS the difference in cost between the two drugs, along with any remaining prescription deductible.

Prescription help on the go

Check out the free Express Scripts mobile app, too, for easy refills and timesaving tools and resources, including order history and tracking, drug pricing and help finding your nearest in-network retail partner.

Helpful resources

For more information about prescription drug coverage, call Express Scripts customer service at 855-712-1403 or log on to the Express Scripts website. You can order home delivery online, by phone or by completing a home delivery form and mailing to the address on the form.

 
Prescription Plans
Annual pharmacy deductible
Annual out-of-pocket maximum
Prescription drugs - 30-day retail
Prescription drugs - 90-day mail or retail
Prescription drug plans
Annual pharmacy deductible
Memorial Hermann ACO $75
Open Access Select $250 - $500
Annual out-of-pocket maximum
Memorial Hermann ACO

Included with medical

Open Access Select

Included with medical

Prescription drugs - 30-day retail
Memorial Hermann ACO $15 - $150
Open Access Select

30%

Prescription drugs - 90-day mail or retail
Memorial Hermann ACO $37.50 - $150
Open Access Select

30%

Specialty - Tier II (Generic/preferred)
Memorial Hermann ACO
Open Access Select

30%

Specialty -Tier III (Non-preferred)
Memorial Hermann ACO
Open Access Select

30%

Prescription drug plans
Annual pharmacy deductible
Memorial Hermann ACO $75
Open Access Select $250 - $500
Annual out-of-pocket maximum
Memorial Hermann ACO

Included with medical

Open Access Select

Included with medical

Prescription drugs - 30-day retail
Memorial Hermann ACO $15 - $150
Open Access Select

30%

Prescription drugs - 90-day mail or retail
Memorial Hermann ACO $37.50 - $150
Open Access Select

30%

Specialty - Tier II (Generic/preferred)
Memorial Hermann ACO
Open Access Select

30%

Specialty -Tier III (Non-preferred)
Memorial Hermann ACO
Open Access Select

30%

Prescription drug plans
Annual pharmacy deductible
Memorial Hermann ACO $75
Open Access Select $250 - $500
Annual out-of-pocket maximum
Memorial Hermann ACO

Included with medical

Open Access Select

Included with medical

Prescription drugs - 30-day retail
Memorial Hermann ACO $15 - $150
Open Access Select

30%

Prescription drugs - 90-day mail or retail
Memorial Hermann ACO $37.50 - $150
Open Access Select

30%

Specialty - Tier II (Generic/preferred)
Memorial Hermann ACO
Open Access Select

30%

Specialty -Tier III (Non-preferred)
Memorial Hermann ACO
Open Access Select

30%

Prescription drug plans
Annual pharmacy deductible
Memorial Hermann ACO $75
Open Access Select $250 - $500
Annual out-of-pocket maximum
Memorial Hermann ACO

Included with medical

Open Access Select

Included with medical

Prescription drugs - 30-day retail
Memorial Hermann ACO $15 - $150
Open Access Select

30%

Prescription drugs - 90-day mail or retail
Memorial Hermann ACO $37.50 - $150
Open Access Select

30%

Specialty - Tier II (Generic/preferred)
Memorial Hermann ACO
Open Access Select

30%

Specialty -Tier III (Non-preferred)
Memorial Hermann ACO
Open Access Select

30%

Find a network provider

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For any benefits question or concern, including 24/7 Nurse Line access, one call does it all.
Call us at 866-284-AISD (2473)