Prescription Drug and Pharmacy Information for Federal Employees
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 2024 Standard and Basic Option plans, insured by Medical Mutual.
Find a Pharmacy
Medical Mutual’s pharmacy network through Express Scripts includes more than 1,400 locations in the FEHB 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.
- Please note If you prefer to continue filling your prescriptions at your local retail pharmacy, you need to let ESI know before the fourth fill so you will not be charged more for your medication and for the amount you pay to continue to apply to your deductible and/or out-of-pocket. Additional details regarding the Select Home Delivery Active Choice Program are provided below.
You can download and print a copy of the form. Standard shipping is FREE!
Select Home Delivery Active Choice Program
If you take any long-term prescription drugs, your plan offers the Select Home Delivery Active Choice program to help save you time and money. This program allows you to skip the line at the pharmacy and have your medications shipped directly to you. Refills will be sent in plenty of time before you run out. If you’d prefer to continue to pick up long-term prescriptions at your local pharmacy, you’ll need to notify Express Scripts of your preference before the fourth fill so you will not be charged more for your medication and for the amount you pay to continue to apply to your deductible and/or out-of-pocket. If you prefer to continue filling your prescriptions at your local retail pharmacy, you need to let ESI know of your preference, just call the Rx Information number listed on your member ID card.
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 the Walgreens Advantage Pharmacy Network with over 40,000 participating retail pharmacies nationwide, including over 1,400 in Ohio. Our network includes many popular chains, such as Costco, Rite Aid, Walgreen’s and Wal-Mart.
Please note: CVS and some independent pharmacies are not covered.
Contraceptive Coverage
With Medical Mutual’s Federal Employees Health Benefits Program, you have access to contraceptive coverage at no cost to you. Please view this flyer for additional information on $0 coverage for preventive care benefits under the Affordable Care Act (ACA).
You can also reference the National Preferred Formulary guidebook to see which specific contraceptive medications are included at a $0 costshare. The Obstetrics & Gynecology section begins on page 165 and $0 ACA preventive medications are identified with Drug Tier 5 and category of ACA.
Additional information regarding your contraceptive coverage can also be found by visiting the OPM website.
List of Covered Drugs and their Costs
Medications covered by the FEHB 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 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 |
| Generic (Tier 1): 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) | $75 per fill | 40% up to a $250 maximum per fill |
| Preferred Brand (Tier 2): Mail Order (up to a 90-day supply) | $150 per fill | 40% up to a $500 maximum per fill |
| Non-preferred Brand (Tier 3): Retail (up to a 30-day supply) | $180 per fill | 60% up to a $350 maximum per fill |
| Non-preferred Brand (Tier 3): Mail Order (up to a 90-day supply) | $360 per fill | 60% up to a $700 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.
Need Help?
If you have questions or need help, please call FEHBP Employees/Annuitants Customer Care:
Call 1-800-315-3144 (TTY 711 for hearing impaired)
Monday – Thursday: 7:30 a.m. to 7:30 p.m.
Friday: 7:30 a.m. to 6 p.m.
Saturday: 9 a.m. to 1 p.m.
All times are Eastern Standard Time