Express Scripts are based in Missouri. Among other services, the company offer three Medicare Part D prescription drug plans.
The plans range in cost from low premiums and low copays to broad coverage and a low deductible.
This article looks at Express Scripts Medicare prescription drug plans in more detail, including the costs and eligibility.
Express Scripts have been around since their founding in 1986. Cigna acquired them in 2018, and they became part of Evernorth in 2020. Among other services, the company offer three Express Scripts Medicare prescription drug plans.
Each of the Express Scripts prescription drug plans includes a list, called a formulary, of the drugs that the plan covers. The formulary sets these drugs out in five or six tiers, depending on the plan. Tier 1 usually includes the least expensive generic drugs, while the most expensive brand name drugs are in the highest tier.
The company provide an online tool for a person to search for plans that cover their prescription.
With the Express Script prescription drug plan, a person can choose which pharmacy to use. The company’s online tool allows a person to compare mail order and retail drug prices.
Federally funded Medicare is a health insurance program for older people in the United States. Some younger people with disabilities also qualify for Medicare.
The program consists of four parts:
- Part A is hospital insurance.
- Part B is for medical insurance.
- Part C, known as Medicare Advantage, provides an alternative to original Medicare (Part A and Part B) and may offer additional benefits.
- Part D provides coverage for prescription drugs.
Private companies offer Medicare Part D prescription drug plans, which first became available in 2006.
Plan costs vary, as does the list of covered drugs. Each Part D plan has a formulary that lists all of the drugs that it covers, including generic and brand name options.
For 2021, the basic Part D premium will be $33.06, according to the Centers for Medicare & Medicaid Services (CMS). Additional costs include out-of-pocket expenses, such as the annual deductible, copays, or coinsurance.
Other factors that may affect overall costs include the tier in which the drug sits and whether it is a generic or brand name medication.
In addition, a person must pay the plan deductible, after which they will pay a maximum of 25% of the cost of either generic or brand name drugs, up to a total of $4,130.
Once a person’s out-of-pocket drug costs total $6,550, they reach catastrophic coverage, according to the CMS. From that point, in 2021, a person will pay a minimum copay of $3.70 for a “generic/preferred multi-source drug” and $9.20 for all other drugs.
Express Scripts offer three plans, each with different benefits and costs. The plans — named Saver, Value, and Choice — got a combined rating of 3 stars for 2020. The chart below shows some of the plans’ costs:
|Saver||From $18.50 in Michigan to $32.40 in Alaska||$0 for generic drugs in tiers 1 and 2 and select insulins in tier 3, and $285 for all other drugs||$0 to $105, depending on the tier||$6,550|
|Value||From $25.70 in Alabama to $61 in California||$0 for tiers 1, 2, and 6, and $445 for tiers 3, 4, and 5||$0 to $141, depending on the tier||$6,550|
|Choice||From $63.40 in Louisiana to $86.70 in Illinois||$0 for tiers 1, 2, 3, and 6, and $100 for tiers 4 and 5||$0 to $126, depending on the tier||$6,550|
This online tool will help a person check for available Express Scripts prescription drug plans by zip code.
A person must also pay the Medicare Part B premium, which is $148.50 in 2021 for a person with an annual income of $88,000 or less. A person with a higher annual income may pay higher premiums.
A person enrolled in original Medicare (Part A and Part B) is eligible to get a Part D drug prescription plan. They can get this alongside their original Medicare plan or enroll in a Medicare Advantage (Part C) plan with prescription drug coverage.
Enrollment in a Part D plan is optional, but if a person chooses to enroll at a later date, there may be penalties. If a person has alternative coverage, such as through an employer, or is in receipt of Extra Help, they may not incur a late enrollment penalty.
All companies offering the plans must provide a basic level of coverage, although costs vary among plans.
Express Scripts offer three Medicare Part D prescription drug plans: Saver, Value, and Choice. Each plan has a 3-star rating with Medicare.
Premiums and other costs for Express Scripts prescription drug plans depend on the individual plan and the person’s location.