Page 11 - Busey Corporation 2022 Benefits Guide
P. 11
2022 Benefits Guide
Prescription Drug Coverage
Prescription drug beneits under all plans is ofered through Express Scripts. Our plan utilizes Express Scripts’
full network.
The below chart outlines the beneits for the prescription drug plan. The prescription drug beneits on these
plans are based on whether the drug is considered a generic, preferred brand, or non-preferred brand. Our
plan allows for a 30-day supply at a retail pharmacy, or a 90-day supply through mail order. We utilize the
Express Scripts’ Smart90 program.
The Smart90 program is speciic to our members who utilize long-term drugs, also called maintenance
medications, that are taken on an ongoing basis. The Smart90 program is intended to save you trips to
the pharmacy, allow for payments every three months vs. monthly, and create lower overall prices due to
purchasing in larger quantities. Express Scripts Pharmacy will deliver your 90-day supply medications to your
door for free; you also have the option to ill your prescription in person at any in-network retail pharmacy.
Under the Smart90 program, you will need to make an active election by visiting
express-scripts.com/90day, to continue to ill your maintenance medications with a 30-day or 90-day
supply. If you do not make an active election, you will be defaulted into being covered only by the 90-day
supply. This means you will be responsible for the full retail cost of your 30-day supply of maintenance
medications moving forward. For more information, or if you need help locating a pharmacy, visit
express-scripts.com.
With a CDHP plan, all prescription drugs are subject to the medical deductible before cost sharing begins.
With the PPO plan, there is a copay based on the tier level the prescription falls on. There is 100% coverage
on certain preventive medications under either the CDHP or PPO plans.
Prescription Drugs
2800 CDHP 5000 CDHP 1500 PPO
In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network
Retail— 30 days 30 days
Supply Limit
80% after 50% after 100% after 50% after 50% after
Tier 1 $10 copayment
deductible deductible deductible deductible deductible
80% after 50% after 100% after 50% after 50% after
Tier 2 $40 copayment
deductible deductible deductible deductible deductible
80% after 50% after 100% after 50% after 50% after
Tier 3 $70 copayment
deductible deductible deductible deductible deductible
Mail Order— 90 days 90 days
Supply Limit
80% after 100% after
Tier 1 $27.50 copayment
deductible deductible
80% after 100% after
Tier 2 Not covered Not covered $110 copayment Not covered
deductible deductible
80% after 100% after $192.50
Tier 3
deductible deductible copayment
11
Prescription Drug Coverage
Prescription drug beneits under all plans is ofered through Express Scripts. Our plan utilizes Express Scripts’
full network.
The below chart outlines the beneits for the prescription drug plan. The prescription drug beneits on these
plans are based on whether the drug is considered a generic, preferred brand, or non-preferred brand. Our
plan allows for a 30-day supply at a retail pharmacy, or a 90-day supply through mail order. We utilize the
Express Scripts’ Smart90 program.
The Smart90 program is speciic to our members who utilize long-term drugs, also called maintenance
medications, that are taken on an ongoing basis. The Smart90 program is intended to save you trips to
the pharmacy, allow for payments every three months vs. monthly, and create lower overall prices due to
purchasing in larger quantities. Express Scripts Pharmacy will deliver your 90-day supply medications to your
door for free; you also have the option to ill your prescription in person at any in-network retail pharmacy.
Under the Smart90 program, you will need to make an active election by visiting
express-scripts.com/90day, to continue to ill your maintenance medications with a 30-day or 90-day
supply. If you do not make an active election, you will be defaulted into being covered only by the 90-day
supply. This means you will be responsible for the full retail cost of your 30-day supply of maintenance
medications moving forward. For more information, or if you need help locating a pharmacy, visit
express-scripts.com.
With a CDHP plan, all prescription drugs are subject to the medical deductible before cost sharing begins.
With the PPO plan, there is a copay based on the tier level the prescription falls on. There is 100% coverage
on certain preventive medications under either the CDHP or PPO plans.
Prescription Drugs
2800 CDHP 5000 CDHP 1500 PPO
In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network
Retail— 30 days 30 days
Supply Limit
80% after 50% after 100% after 50% after 50% after
Tier 1 $10 copayment
deductible deductible deductible deductible deductible
80% after 50% after 100% after 50% after 50% after
Tier 2 $40 copayment
deductible deductible deductible deductible deductible
80% after 50% after 100% after 50% after 50% after
Tier 3 $70 copayment
deductible deductible deductible deductible deductible
Mail Order— 90 days 90 days
Supply Limit
80% after 100% after
Tier 1 $27.50 copayment
deductible deductible
80% after 100% after
Tier 2 Not covered Not covered $110 copayment Not covered
deductible deductible
80% after 100% after $192.50
Tier 3
deductible deductible copayment
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