Your Pharmacy Benefits

View your pharmacy benefits and compare drug prices through our secure member website, My Health Plan, which gives you direct access to Express Scripts, our pharmacy benefit manager.

If you are a Medical Mutual member, register or log in to My Health Plan.

If you are not a member yet, please review the following information and links for additional information about the 2019 Standard and Basic Option plans, insured by Medical Mutual.

Find a Pharmacy

Medical Mutual’s pharmacy network through Express Scripts includes more than 834 locations in the FEHB Northeast Ohio service area. Find a network pharmacy near you.

Prescription Processing

Mail Order Prescriptions

Save time and money, and have your long-term medications delivered right to your door through the Express Scripts Home Delivery pharmacy. Ask your doctor or health provider to write you a prescription for up to 90 days, plus three refills (if applicable). Then:

  • Your doctor can fax it to Express Scripts at (800) 837-0959 or send it through their e-prescribing system, OR
  • Complete a mail-order form and send it, along with your prescription, to Express Scripts at the address on the form.

You can download and print a copy of the form. Standard shipping is FREE!

Retail Prescriptions

Express Scripts administers your prescription drug benefit on behalf of Medical Mutual. As a plan member, you’ll have access to award-winning customer service and 60,000 participating retail pharmacies nationwide, including 2,500 in Ohio. Our network includes many popular chains, such as Costco, Rite Aid, Walgreen’s and Wal-Mart.

List of Covered Drugs and their Costs

Medications covered by the FEHB High, Standard and Basic Option plans, insured by Medical Mutual, are listed on our preferred drug list. This list is also known as a formulary. Please check the formulary to see how your medication is covered by your plan and at what copay tier. 

You can use the online formulary search tool to check coverage or compare prescription medication costs . To use the tool:

  • Click “Go” under FEHB Open Season
  • Select the High, Standard, or Basic plan
  • Select either “Formulary – look up drugs by name” or “Compare prescription medication costs” option

Prescription drugs must be filled through a network retail pharmacy (up to a 30-day supply) or the Express Scripts Home Delivery pharmacy (up to a 90-day supply).

Copay tiers are as follows:

   
Standard Option Basic Option
Generic (Tier 1)  Retail (up to a 30-day supply)   $15 per fill  $10 per fill 
 Mail Order (up to a 90-day supply) $30 per fill $20 per fill
Preferred Brand (Tier 2)   Retail (up to a 30-day supply) $65 per fill 40% up to a $125 maximum per fill
 Mail Order (up to a 90-day supply)
$130 per fill 40% up to a $250 maximum per fill
 Non-preferred Brand (Tier 3)  Retail (up to a 30-day supply) $160 per fill 60% up to a $250 maximum per fill
 Mail Order (up to a 90-day supply) $320 per fill 60% up to a $500 maximum per fill
 Specialty1 (Tier 4)  Up to a 30-day supply filled at a contracted specialty pharmacy through the Specialty Drug Solution Program. Mail order is not available for specialty medications.
25% up to $500 per fill 30% up to $500 per fill

1See additional information about specialty drugs below.

Specialty Medications

Specialty medications must be filled at our contracted specialty pharmacies: Accredo and Gentry Health Services and are limited to a 30-day supply per fill. To see which medications are considered specialty, look for drugs noted as “Tier 4” in our formulary.

For more information, please review our Specialty Drug Solution flier

Standard Plus Preventive Medications

Getting preventive care and taking preventive medications can be an important step people take to avoid many illnesses and maintain a good health. Medical Mutual has adopted the following list of preventive medications to support this goal. Find out more information here.

Submitting a Paper Claim

Download a Prescription Drug Claim form. Use this form if you forget your ID card at time of purchase at a retail pharmacy, and/or when the pharmacy cannot submit a claim electronically for you. You will maximize your benefits and pay the lowest price when you use your ID card at time of purchase.