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Your prescription drug co-payments at a glance
Show this to your doctor and discuss ways to pay less for your medications.
If you need a long-term medication, you’ll pay less over time by using the Medco PharmacyTM mail-order service
instead of a drugstore. We’ll deliver up to a 90-day supply right to you—and standard shipping is free. Take the enclosed mail-order form and envelope to your doctor and ask if a 90-day prescription would be right for you. Through the Medco Pharmacy
31-day supply
32- to 60-day supply: $20
61- to 90-day supply: $20
31-day supply
61- to 90-day supply: $50
31-day supply
61- to 90-day supply: $87.50
You’ll pay more for your long-term drugs (such as those used to treat high blood pressure or high cholesterol) unless you order your prescriptions through the mail by using the Medco Pharmacy. The Ⴁrst three times that you purchase a long-term drug at a participating retail pharmacy, you’ll pay your retail co-payment for up to a 31-day supply. After the third purchase at retail, you’ll pay the entire cost if you continue to purchase it at retail. For short-term prescriptions, such as antibiotics, use a retail pharmacy As a Medco member, you can go to any of nearly 60,000 retail pharmacies, including most major drugstores. Just ask your local pharmacy if it’s in the Medco network. You can also visit www.medco.com and click “Locate a pharmacy” or call Member Services toll-free at 1 800 230-0508. Medco may contact your doctor about your prescription If you are prescribed a drug that is not on your health plan’s preferred list, yet an alternative plan-preferred drug exists, we may contact your doctor to ask whether that drug would be appropriate for you. If your doctor agrees to use a plan-preferred drug, you will usually pay less. Drug coverage: Federal legend drugs, state-restricted drugs, certain self-administered drugs Drug exclusion: Non–federal legend drugs, over-the-counter (nonprescription) drugs, certain injectable drugs KEEP THIS INFORMATION
If you have any questions after you start using your beneႡt, please call Member Services toll-free at 1 800 230-0508. Some medications won’t be covered unless you receive preapproval. You may need approval for coverage of the medication or for additional quantities. Medications may fall under one or more programs. Preapproval may be obtained through a coverage review. The review determines whether your plan will cover your prescription. Here are some examples of common medications that may require preapproval: - Acne medications (such as tretinoin (generic Retin-A®) and Tazorac®) - Medications to treat cancer (such as ErbituxTM and Gleevec®) - Medications to treat low red and white blood cell counts (such as Procrit® and Neupogen®) - Medications to treat chronic hepatitis B or chronic hepatitis C (such as Intron A® and Pegasys®) - Medications to treat multiple sclerosis - Medications to treat severe asthma (such as Xolair®) - Medications to treat narcolepsy (Provigil®) Coverage for some medications may be determined by using data on Ⴁle, such as medical history, drug history, age, or gender. For these medications, coverage may be provided without the need for a coverage review. Here are some examples of medications that may qualify for coverage without need for a review: - Medications for treatment of rheumatoid arthritis (such as Enbrel® and Humira®) - Medications used for pain management (such as Celebrex®, fentanyl citrate (generic version of Actiq®)) - Medications to treat hepatitis C (such as ribavirin) - Medications used to treat depression (such as Wellbutrin XL®) - Medications used to treat eczema (such as Elidel®) Authorization for additional amounts For some medications, your plan may cover a limited amount within a set time. The medications listed below are authorized for limited quantities only. For some medications, a coverage review may be available for requesting additional quantities. (The following is not a complete list, and all medications are subject to change.) - Medications to treat nausea and vomiting due to chemotherapy (such as Anzemet® and Emend®) - Medications to treat migraine headaches (such as Amerge®, Imitrex®, Relpax®) - Medications used for pain management (such as fentanyl citrate (generic version of Actiq®)) - Medications used to treat sleep disorders (such as zolpidem (generic version of Ambien®) or Lunesta®) Medco manages your prescription drug beneႡt for Seton Hall University.

Source: http://www.shu.edu/offices/human-resources/upload/Express-Scripts-MEDCO-Plan-Summary.pdf