Prescription Drugs

New PPO Plan

Prescription drug coverage will be provided through OptumRx beginning January 1, 2016.  OptumRx will replace the current company which is Express Scripts.  When your doctor prescribes medication, you have choices about where and how the prescription is filled. There is a separate out-of-pocket maximum with the new PPO Plan prescription drug expenses of $2,000 for single coverage and $4,000 for family coverage.

Your out-of-pocket cost for prescription drugs depends on those choices:

Expense
Your Cost for Prescription Drugs
OptumRx Network
Out-of-Network
Retail Pharmacy (per 30 day supply)
You pay 100% (not covered)
Generic $8 copay
Preferred Brand 20% coinsurance ($40 minimum, $60 maximum)
Non-preferred Brand 30% coinsurance ($60 minimum, $80 maximum)
Mail Order (per 90 day supply)
Generic $16 copay
Preferred Brand 20% coinsurance ($80 minimum, $120 maximum)
Non-preferred Brand 30% coinsurance ($120 minimum, $160 maximum)

Health Savings Plan

Prescription drug expenses count toward the same deductible and out-of-pocket maximum as any other medical expense.

For non-preventive medications you pay the full amount of the prescription drug until you reach the medical plan deductible. Then, you pay 10% coinsurance up to the annual out-of-pocket maximum. The coinsurance percentage you pay is the same, regardless of where and how your prescription is filled.

For further assistance, you may contact us at hr@bu.edu or call 617-353-2380.