Prescription Drug Plan

Managing and improving the full spectrum of your employees’ health is important and may even seem a bit daunting. Medical Mutual can help. We have a long-standing relationship with Express Scripts (formerly Medco Health Solutions Inc.), our pharmacy benefit manager (PBM) partner, to administer our prescription drug plans. More than 1,000 pharmacists, nurses and physicians at Medical Mutual and Express Scripts are focused on your employees’ health. Our partnership brings you a strong clinical foundation and a variety of plan options designed to develop the best solution for your employees.

Together with our PBM partner, we offer prescription drug coverage that is integrated with our health plans. We make the administration of your prescription drug program simple –– you only need to send one eligibility file to us, instead of sending multiple files to multiple vendors. Your employees will have one ID card for both their medical and prescription drug needs. And, with access to both prescription drug and medical claims, we can easily identify health management opportunities.

Plus, our integrated solution is all-inclusive. With the exception of one program, you and your employees will receive the advantages of all of our integrated prescription drug and clinical programs at no additional fee.

Prescription Drug Plan Features

Safety and appropriate drug use is important to us, and we know it’s important to you. We can enhance your employees’ care by integrating their prescription drug use with care management initiatives; ensuring care is aligned across prescription drug and medical benefits. Our approach offers convenient, cost-effective and coordinated health plan administration for you and your employees.

Prescription Drug Plan Options:

Tiered Copays: You can choose from a variety of co-pay options (4-tier, 3-tier, 2-tier), and each option offers potential savings for both you and your employees. Drug tiers are typically defined from lowest to highest copay as Generics, Formulary (preferred brand name), Non-formulary (non-preferred brand name) and Specialty.

Generic Incentives: Encourage your employees to choose the more cost-effective, generic version of a drug (if available).

Mail-Order Incentives: Employees can get up to a 90-day supply of long-term drugs for a single mail-order copay, offering additional savings and convenient home delivery.

Clinical Program Options:

We make every effort to monitor medication use so you can improve the health of your employees and help manage your overall prescription drug costs. Clinical program options that can be combined with benefit design options include:

Coverage Management programs such as prior approval (is the drug covered under your benefits?), step therapy (is the lowest-cost and most effective drug being prescribed?) and quantity duration (is the employee using the appropriate quantity of a medication over a defined period of time?) are used to monitor and optimize drug use, encourage the right patient and provider behaviors and help avoid compromised care and unnecessary costs.

Groups that implement these programs typically save an average of 4 percent to 8 percent of their prescription drug cost each year based on Medco’s experience.

Express Scripts’ RationalMed® program (available for an additional fee) alerts prescribers and dispensing pharmacists about member safety issues, gaps in care and other health-related concerns based on integrated medical and prescription drug claims.

We also offer several Drug Utilization Review (DUR) programs to ensure the safe use of medications and prevent adverse health outcomes.

Need More Information?

For more information, please call your sales representative or broker. You may also request an online quote.