Benefits – Prescription Drugs

There are changes within the pharmacy network!!

Sam’s Club Pharmacy, Kroger Pharmacy, and some independent pharmacies will no longer be included in network. Below is a list of the independent pharmacies within Indiana that are no longer in network. If you need to move your prescription to a new pharmacist, please see the instruction How to Change Pharmacies.

COWAN DRUGS
FAMILY HEALTH CENTER PHARMACY
FAMILY DRUG HEALTH MART – SEYMOUR
GENOA HEALTHCARE
HAMPTON LIGGET DRUGS
PLATTE VALLEY PHARMACY
RX FOR LESS PHARMACY
THE SOUTH BEND CLINIC PHARMACY
WILLIAMS BROS HEALTH CARE PHARMACY

How does the prescription plan work?

All of Cummins’ medical plans include prescription drug coverage to support your health and wellbeing. The plan is administered by Express Scripts. Whether you fill your prescriptions at retail pharmacy or get them delivered using the mail order option, the Express Scripts support team are here to help you understand your plan, provide coverage details and your claim history, check if a medication is covered and compare prices, and more. Express Scripts have pharmacists or service representatives available 24/7 to help answer your health and insurance questions.

You can reach the Express Scripts care team at 1-866-544-6968 or online at expressscripts.com

What you pay for your prescriptions depends on the type of prescription you use and where you purchase it. With the exception of preventive prescription drugs, you pay 100% of the cost until you meet your medical plan’s deductible. Once met, your cost is based on the type of drug you use (generic, formulary and non-formulary), and whether you go to a participating pharmacy or use the mail-order feature.

What does the prescription plan cover?

Plan Feature	HSA 3200		HSA 1600		PPO Plan
	In-Network	Out-of-Network	In-Network	Out-of-Network	In-Network	Out-of-Network
Prescription Drug Deductible (included in medical plan deductible, except for certain preventive drugs) (Individual/Family)	$3,200 / $6,400	$6,400 / $12,800	$1,600 / $3,200	$3,200 / $6,400	Not applicable (Prescription drug expenses are not counted toward the calendar-year deductible)
Preventive Drug List	Not subject to deductible; copay/coinsurance applies*
Retail Prescriptions (up to 34-day supply)**
Generic	After deductible: Plan pays 100% after $8 copay		Same coverage as in-network, limited to reasonable and customary amounts		$10 copay
Brand Name Preferred	After deductible: Plan pays 80% (you pay 20%); $30 min/$150 max				$40
Brand Name Non-preferred	After deductible: Plan pays 50% (you pay 50%); $65 min/$180 max				$80
CVS/Walgreens Retail or Mail Order Prescriptions (up to 90-day supply)**
Generic	After deductible: Plan pays 100% after $20 copay				$20 copay
Brand Name Preferred	After deductible: Plan pays 100% after $75 copay				$80 copay
Brand Name Non-preferred	After deductible: Plan pays 100% after $180 copay				$160 copay
Specialty Pharmacy	After deductible: Plan pays 100% after $60 copay for a 30-day supply or $180 for a 90-day supply				$60 copay for a 30-day supply or $180 copay for a 90-day supply

*Copay/coinsurance for preventive drugs doesn’t count toward your deductible, but is applied toward your annual out-of-pocket maximum. Preventive drugs per the Affordable Care Act are $0. All other preventive drugs under section 223(c)(2) of the Internal Revenue Code have the listed copays and coinsurance with minimums and maximums.
**If the actual cost of the prescription is less than the copay or minimum dollar amount, you pay the actual cost.
***Specialty is only available at Accredo Specialty pharmacy***

Prescription Delivery Option!

Get your longer-term medicine delivered from the Express Scripts Pharmacy in secure, weather-resistant packages. Whether starting a new prescription or refilling an old one, it’s easy to get medication with home delivery. Please consult with a doctor before starting this request.

Free shipping with online tracking*
Pay after your medicine ships
Talk with an Express Scripts pharmacist any time
Get texts and emails about orders and refills

How does this work?

You’ll request to have the medication delivered
Express Scripts will contact the doctor to get the prescription. For faster service, ask your doctor to send your prescription electronically to Express Scripts® Pharmacy home delivery.
After we receive your prescription, you can expect to receive your medication within 5-7 days.

Choose the medicine you want us to deliver in up to a 3-month supply! Concerned about paying for a 3 month supply? Use Extended Payment Program, information below!

Extended Payment Program (EPP)

The Extended Payment Program lets you pay for your delivery prescriptions in three monthly installments, or payments, instead of paying the full amount all at once. Each monthly payment is automatically processed using your preferred payment method.