MESSA’s new MESSA Saver Rx drug program is designed to help MESSA members save money and stay healthy by providing discounted copayments on more than a hundred maintenance drugs prescribed for chronic conditions. MESSA Saver Rx will also reduce health care costs over the long term for our members and for their MESSA health plans by providing lower copayments for prescription drugs that are critical to managing chronic conditions and symptoms.
With MESSA Saver Rx, copayments range from $2 to $40 (and more than $40 if a patient insists on purchasing a brand name when a generic is available and medically appropriate). MESSA Saver Rx provides many cost-effective strategies that help you save money by giving you the power to reduce your copayments and limit your out-of- pocket costs while supporting your good health. Talk with your doctor about generic options, including “therapeutic alternatives,” and ask for 90-day prescriptions for maintenance medications. 8 Ways to Save 1 $2 copayment for up to a 34-day supply of generic
drugs when no generic exists. You can reduce your brand
maintenance medications for specific chronic conditions
name copayment by asking your doctor for a 90-day
and diseases, including more than a hundred generics used
prescription and about generic “therapeutic alternatives.”
to treat asthma, diabetes, high blood pressure and high cholesterol.
6 Whenever possible choose generics. There is a $40
copayment plus the difference between the BCBSM-
2 $10 copayment for up to a 34-day supply of all other
approved amount and the retail cost of the drug (which
can be substantial) when the patient insists on a brand name drug when a generic is available and medically
3 $10 copayment for up to a 34-day supply of Over-the-
Counter (OTC) medications used to treat heartburn and seasonal allergies. A prescription for the OTC drug is
7 Save with a 90-day retail network pharmacy. Most
required and must be presented and filled at the pharmacy
Michigan pharmacies participate in the BCBSM/MESSA
counter in order to be covered. You pay only a $10
90-day retail network. Fill a 90-day prescription and only
copayment and the pharmacy will bill your health plan.
pay two copayments—saving a full copayment every three
Covered OTC drugs are: Prilosec®, Prevacid®, Zegerid®,
months. Important note: See #6 above.
Claritin®, Claritin D®, Zyrtec® and Zyrtec D®. 8 Save with Medco-by-Mail. Purchase a 90-day supply of 4 $20 copayment (reduced from $40) for up to a 34-day
a maintenance medication from MESSA’s exclusive mail
supply for specific brand name maintenance drugs used to
order pharmacy, Medco-by-Mail. Similar to purchasing
treat diabetes and asthma. For diabetes, covered drugs are
from a 90-day retail network pharmacy, Medco-by-Mail
Insulin and Glucagon emergency kits. For asthma, covered
provides a 90-day supply (with a 90-day prescription) for
drugs are fast-acting and long-lasting inhalers and drugs in
the price of two copayments. Full details on mail order
the “Leukotriene Modifiers” therapeutic class like Singulair®.
purchasing are available in the Prescriptions by Mail area at www.messa.org. Important note: See #6 above. 5 $40 copayment for up to a 34-day supply of brand name MESSA Saver Rx: Important Notes and Additional Information
1. There are more than a hundred generic prescription
3. MESSA Saver Rx includes an annual $1,000 per
drugs that are eligible for the $2 copayment provision
person/$2,000 per family copayment maximum. When
in MESSA Saver Rx. The list can change daily as new
a generic is available and the member insists on the
generics come to market. Because of the large size of
brand name drug, the charges above the $40 brand name
the list and its quick-changing nature, as a member
copayment do not count toward the annual maximum.
convenience MESSA defines the list of drugs eligible for
4. Plan coverage is available at out-of-state pharmacies
the $2 copayment based on the medical condition and by
associated with Medco. If a member is outside
large “therapeutic classes” of generics. The conditions and
of Michigan and needs to fill a prescription, she
should call ahead or ask the pharmacists to make
sure the pharmacy participates with Medco. MESSA
members can also search for a participating pharmacy
at www.messa.org or call the MESSA Member Service
c. High blood pressure, high cholesterol and coronary
5. If a member’s physician writes DAW for a brand name
when a generic is available, the member could incur
substantial costs above the copayment amount. The
physician may request an exception for the patient to
take the brand name by submitting documentation that
the patient has tried the generic and it is not appropriate
because of side effects or because it is ineffective.
The information in this program overview of the MESSA Saver Rx plan is intended to be general in nature and not
2. Patients cannot combine a coupon or other manufacturer definitive. This information is current as of July 1, 2010.
offer with Over-the-Counter drugs (Prilosec, Prevacid,
If you have specific questions about plan coverage under
Zegerid, Claritin, Claritin D, Zyrtec and Zyrtec D)
MESSA Saver Rx, please call MESSA’s award-winning
covered by the $10 copayment. A prescription for the
Member Service Center at 800.336.0013.
OTC drug is required and must be presented and filled at the pharmacy counter in order to be covered. This list may be updated over time due to market changes.
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MESSA • 1475 Kendale Boulevard • P.O. Box 2560 • East Lansing, MI 48826-2560 • 517.332.2581 • 800.292.49107/10
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