Your Prescription Drug Coverage

When you fill a prescription, the copayment you pay at the pharmacy is determined by the tier your medication falls on. Medications are placed on tiers according to a variety of factors, including what they’re used for, their cost, and whether equivalent or alternative medications are available. 

A copayment is the set price you pay for up to a 30-day supply of your prescription drug. You pay the copayment even if your physician prescribes less than a 30-day supply of your medication.

Copayments for Prescriptions

Tier 1: Most generic drugs - $7

Tier 2: Preferred brand name drugs - $20

Tier 3: Non-preferred brand name drugs - $45

Limitations and restrictions may apply to certain medications. Some drugs may also require a pre-approval process between the doctor's office and Express Scripts.

Look-up Your Prescription Copayment Estimate

Visit Express Scripts Pharmacy Benefit Estimate Tool (express-scripts.com) and follow the instructions below:

• Select the HUGHP plan that applies to you (HUGHP HMO POS Nonunion, HUGHP HMO POS Union, or HUGHP POS Plus Nonunion) and click “View Details”
• Select the “Price a Medication” box
• Type in the name of the medication and provide all information that is listed in the boxes below the medication box tool

Note: Information provided on the Express Scripts website is an estimate only.

Preventive Medication List

Certain medications used to prevent or manage the treatment of chronic conditions will be available at reduced or no cost. Examples of conditions that medications on this list may treat include asthma, high blood pressure, high cholesterol, and diabetes.

For additional information, please see the preventive medications FAQs.

Prescription Formulary

Certain medications may change copayment tiers, may no longer be covered, or may move into a formulary management program (e.g., require prior authorization). If impacted, you will receive a letter from Express Scripts about the change in coverage.

Specialty Prescriptions

Specialty medications are high-cost prescription drugs used to treat complex or chronic conditions. These medications often require special handling and administration and are carefully supervised by health care providers. Most specialty prescriptions must be purchased through an approved network Specialty Pharmacy.

If you need to fill a specialty medication, you will either need to fill the medication through Accredo or Freedom Fertility (both through mail order).

Accredo

• Contact Accredo to set up an account in order to get specialty medications delivered.

• Have your prescribing doctor send your prescription to Accredo to be filled through Accredo Health Group, Inc or by calling (800) 803-2523

• Accredo will work with your doctor to get your prescription and they'll contact your health plan about your benefits.

• Accredo will call you to schedule free delivery to your home or doctor’s office¹ on a date that works for you. They’ll ship your medication with any special handling it may need, such as refrigeration.

• Once you receive your first order, register online to easily order refills,² set up reminders, and get the status of your future shipments.

1. As allowable by law.

2. Not available for all specialty medications.

Freedom Fertility Pharmacy 

Infertility prescriptions are filled by Freedom Fertility Pharmacy.

• For general inquiries and information, contact Freedom's Patient Care Center by calling (800) 660-4283 or emailing help@freedomfertility.com.

How to get started:

• Ask your prescriber to fax your prescription to Freedom.

• Contact Freedom to set up your order and schedule your delivery.

Some specialty medications may be eligible for copay assistance through the PillarRX Copay Assistance Program.

PillarRx Specialty Drug Copay Assistance Program

Harvard University has partnered with the PillarRx Copay Assistance program to reduce your costs for certain specialty medications that you and/or your dependents may be taking. Specialty medications are high-cost prescription medications used to treat complex or chronic conditions. These medications often require special handling and administration and are carefully supervised by health care providers. 

This is a confidential program managed directly by PillarRx. PillarRx can help you secure financial assistance through drug manufacturers that will substantially reduce or completely cover your out-of-pocket costs for your specialty medication(s). Your Pharmacy benefit remains through Express Scripts and is not changed by this program.

Note: 

• Manufacturer assistance dollars may not accumulate toward deductibles and/or out-of-pocket maximums. 

• Medications will still need to be filled through Accredo, the Express Script Specialty Pharmacy. 

• Enrollment in the program is voluntary however, you must actively opt-in if you wish to participate or opt-out if you don’t wish to participate. If you don’t take action, you may be responsible for up to 30% of the cost of the medication.

How to get started:

If you are prescribed an eligible medication, you will be contacted by a PillarRx Care Team Member to help facilitate enrollment in the manufacturer programs. They will:

• Provide details about your current costs

• Enroll you in the program or work with the drug manufacturer(s) to facilitate your enrollment

• Secure savings for you and your family

• Answer any questions you have about the program

The program will then provide ongoing support to:

• Work with your specialty pharmacy to facilitate refills and manage your negotiated out-of-pocket costs 

• Manage claims and ensure your financial assistance is processing as expected

• Work with you and your family/caregiver to manage ongoing communication with the drug manufacturer(s), specialty pharmacy, and your health plan

You will receive a call from a PillarRx Care Team Coordinator to start the process. If you do not receive a call or if you have any questions about the program, you can call them directly at (636) 614-3126.

Prescriptions & Travel

Traveling Within the U.S.

You can fill or refill up to a 30 day supply of most prescriptions at any participating pharmacy in the United States. Your copayment(s) or drug benefits do not change.

If you purchase medication without using your member ID card you may file for reimbursement through Express Scripts. You will be reimbursed at the plan allowed amount minus the applicable copayment. Submit a prescription drug claim form to receive reimbursement.

Traveling Outside the U.S.

Prescriptions that are purchased out of the country are reimbursed at the plan allowed amount minus the applicable copayment. Submit a prescription drug claim form to receive reimbursement.
 

Learn more about the Express Scripts mobile app