Page 14 - 2023 Mersen Benefit Guide

Prescription Drug Coverage

RxBenefits in partnership with Express Scripts is your prescription drug provider for those enrolled in a Mersen Medical Highmark
Blue Cross Blue Shield Plan. Dedicated to meeting your prescription benefit needs, they can be reached at (800) 334-8134 or
RxHelp@rxbenefits.com; Monday through Friday from 8:00 a.m. to 7:00 p.m. EST. After business hours, you will be transferred
directly to Express Scripts (RxBenefits after hour services). The QR code above brings you to the Express Scripts APP.

Maintenance Medications: Treat ongoing conditions like diabetes, high blood pressure, and asthma. In addition to local retail
pharmacy access, your prescription benefit coverage allows these medications to be filled by mail. Please note, you will save more
money refilling your prescriptions using in-network pharmacies. Please refer to the mobile app, or the contact information below to
find in-network pharmacies.

Mail Order Provides: Mail Order QR Code
• Free delivery to your home of up to a 90-day supply
• Confidential, tamper-resistant, and temperature-controlled packaging
• Convenient refill requests online or by phone
• 24/7 access to a registered pharmacist

Getting Started with Mail Order is Easy:
1. Ask your doctor for a new 90-day supply prescription, and up to three refills for each maintenance medication
2. Download the Express Scripts Mail Order Form from express-scripts.com
3. Mail the completed form and prescription to Express Scripts
New or initial orders may take 10-14 business days to process. Be sure to have at least a two-week supply on hand when submitting a
new Mail Order request.

Specialty Medications: Working with RxBenefits is Accredo. Accredo is their specialty pharmacy provider that serves patients with
complex and chronic health conditions, including cancer, hepatitis C, HIV, bleeding disorders and multiple sclerosis. Accredo Specialty
Pharmacy will work closely with you to ensure proper delivery and administration of your medication. A list of specialty medications
and the conditions they treat is available at Accredo.com.

Switch to Accredo Specialty Pharmacy in Just One Step:
Call (800) 803-2523 and speak with an Accredo care specialist. They’ll contact your doctor and handle the paperwork needed to
continue appropriate care. Visit Accredo.com to learn more about the services Accredo provides. If you have any questions about
your prescription benefit coverage, contact Member Services at (800) 334-8134 or RxHelp@RxBenefits.com Monday through Friday
from 8 a.m. – 7 p.m. Eastern.

Summary of Prescription Plan RXBIN: 610014
RXGRP: RXBMERS
Issuer: Rx Benefits/Express Scripts
Pharmacy Member Services:(800) 334-8134
Pharmacist Helpdesk: (800) 922-1557

Base & Choice Plan Copays Prior Authorization

Tier 1 (Generics): $15 Step Therapy and Quantity
Tier 2 ($ Brands): $25 Limits may apply.
Tier 3 ($ Brands): $40
Specialty 10%, maximum $150
Key Plan Copays

Copays do not apply; prescriptions are purchased at RxBenefits’ negotiated rate.

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PLEASE NOTE: Employees covered by a collective bargaining agreement should refer to their union agreement to determine if they are eligible for these plans.