This Prescriptions Benefit document describes how to get prescription medications, what medications are covered and not covered, and what portion of the prescription costs you will be required to pay.
Medco, the Pharmacy Benefit Manager (PBM), manages your prescription drug benefit under contract with the State of Indiana. Medco maintains the Preferred Drug list (also known as a Formulary), manages a network of retail pharmacies and operates Mail Service and Specialty Drug pharmacies. Medco, in consultation with the Plan, also provides services to promote the appropriate use of pharmacy benefits, such as review for possible excessive use, recognized and recommended dosage regimens, drug interactions and other safety measures.
Employees and dependents covered by the State of Indiana prescription drug benefit can use either retail or the Medco Mail Service Pharmacy. Your benefit covers most prescription drugs, plus insulin and some over-the-counter (OTC) diabetes supplies and certain other OTC items considered preventative under the Health Care Reform Act. Certain medications are subject to limitations and may require prior authorization for continued use.
Retail Pharmacies Retail pharmacy service is most convenient for short-term prescription needs. For example, if you need an antibiotic to treat an infection, you can go to one of the many pharmacies that participate in the Medco network. At retail, you can get up to a 30-day supply.
All major chain pharmacies participate in the network. If you are using an independent drugstore, you should confirm whether it participates, too. To find out, visit www.medco.com or call Member Services at 1-877-841-5241.
The Medco Pharmacy, Mail Service Members that need medication on an ongoing basis can ask their doctor to prescribe up to a 90- day supply, plus refills if appropriate. Examples are ongoing therapies to treat diabetes, high cholesterol, high blood pressure, and asthma. Just a single co-payment is required for each 90- day prescription.
Medications are shipped standard delivery at no additional cost. First-time orders are usually delivered within 8-11 days after we receive your order. Refills usually arrive in less time – refills ordered online are usually delivered within 3-5 days and refill orders mailed in are usually delivered within 6-9 days. Medication packages will include instructions for ordering refills, if applicable, and may also include information about the purpose of the medication, appropriate dosage guidelines and other important details. You can track your prescriptions and order refills at www.medco.com or by calling 1- 877-841-5241. Registered pharmacists are available around the clock for consultation.
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