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Mg43568w 1q13 emory member guide_v1_mg43568w 1q13 emory member guide_v1.qxd

Medication Pocket Guide for
Emory Members
Please bring this guide with you on your next doctor visit.
Express Scripts manages your prescription drug benefit for your employer, plan sponsor, or health plan.
Medco is now a part of the Express Scripts family of pharmacies.
UNDERSTANDING YOUR PLAN
The Emory Plan uses a drug formulary, which is a list of
medications that are covered under this prescription drug plan. The
drug formulary is reviewed by your plan to ensure it includes med-
ications for most medical conditions. Tiers within the formulary
have been set up by levels, with accompanying co-payments as
determined by the plan. Emory’s plan goal is to help keep the cost
of prescription drugs affordable and to provide you with the
medications you need to stay healthy.
TALKING TO YOUR DOCTOR
The amount you pay depends on which medication your doctor
prescribes for you. In some circumstances, you may be able to
receive a lower-cost medication. Here’s what you need to do:
• Bring a complete list of your medications to your next • Bring this member guide to your next doctor’s • Review this member guide with your doctor.
• Ask your doctor if there is a brand-name medication available at a lower tier, and thus at a lower cost for you. • Ask your doctor whether any brand-name medications may We encourage you to share this member guide with your doctor at your next visit or before you fill your next prescription. It’s important that you discuss any substitution you are requestingwith your doctor to ensure that the medication that is prescribedachieves the desired results and doesn’t interact with your othermedications, if any. Please discuss any questions or concerns aboutyour drug therapy with your doctor or pharmacist.
UNDERSTANDING THIS GUIDE
• Section I of this guide displays the tier levels when you fill a prescription using a participating retail pharmacy (30-daysupply) or Express Scripts home delivery (90-day supply).
• Section II of this guide is an alphabetical listing of the REVIEWING THIS MEDICATION LIST
This member guide shows the most commonly prescribed
medications by treatment categories and cost levels. This list is
subject to change during the course of the year, as medications
may move from brand-name to generic or generic to over-the-
counter status. Drugs newly approved by the FDA may also be
added to the listing during the year. Please always check with
Express Scripts Member Services at 1 800 939-3758 to determine
which tier your medication is located in within the plan.
UNDERSTANDING YOUR COST BY LEVELS
All covered medications are categorized into five tiers, and
each tier has a different co-payment. Your cost depends on which
tier your medication is in. You pay the lowest amount for med-
ications in Tier 0, and the highest amount for medications in
Tier 4. Your prescription drug plan may include other limits or
exclusions for certain medications before your coverage will
apply. Please contact Member Services at 1 800 939-3758 for
additional information about your prescription drug benefit.
Highest Cost
Co-payment $85 Retail
Co-payment $212.50 Mail Order
Co-payment $55 Retail
Co-payment $137.50 Mail Order
Co-payment $30 Retail
Co-payment $75 Mail Order
Select brand names used to treat diabetes, used to treat other health conditions.
Co-payment $15 Retail
Co-payment $37.50 Mail Order
high blood pressure, and high cholesterol.
Co-payment $0 Retail
Co-payment $0 Mail Order
Select generics used to treat diabetes, CHF, Lowest Cost
high blood pressure, high cholesterol, and brand-name and generic smoking deterrents.
DISPENSE AS WRITTEN (DAW)
If your physician requires that you take a brand-name
medication, although there may be a generic equivalent
available, your physician must either write on the prescription
the letters “DAW” or check the box on the written prescription
indicating “DAW.” This will instruct the pharmacist to fill your
prescription as the physician prescribed instead of as the plan
requires, which is, that brand-name medications that have a
generic equivalent will be filled with the generic. It is important
to note that at retail, if you receive a brand-name drug that has a
generic equivalent, you will be responsible for paying the higher
brand-name drug co-payment as well as the difference in cost
between the generic and the brand-name drug if the
prescription is filled “DAW.”
PURCHASING YOUR MEDICATION - RETAIL (30-DAY
SUPPLY)
To ensure that your prescription medications are covered by the
plan at the highest level, be sure to fill your retail prescriptions at
a participating pharmacy. To locate a participating pharmacy, go
online to Express Scripts’ website at Express-Scripts.com. “DAW”
does apply. (See Dispense as Written section above)
PURCHASING YOUR MEDICATION - EXPRESS SCRIPTS
HOME DELIVERY (MAIL ORDER - 90-DAY SUPPLY)
If you take prescription medication on an ongoing basis
(maintenance medication), you may want to consider filling
your prescription using the Express Scripts home delivery (mail
order) program. You can get a 90-day supply of medication for
2.5 times the monthly co-payment, thus providing you with a
savings every 3 months. For example: Tier 1 medication at retail
would be 3 months x $15 or $45; at mail order, the cost would be
only $37.50. In addition, there is added convenience to mail order
because your prescriptions are mailed directly to your home.
There is no waiting in line at the retail pharmacy or return trips
to pick up your order, as shipping is FREE. “DAW” does not apply.
MANDATORY GENERICS
Using generic drugs is a great way to lower your prescription
drug costs. If your physician prescribes a brand-name drug and
does not specify Dispense as Written (“DAW”), most likely, the
pharmacist will fill the prescription with a generic equivalent.
EXPLAINING THE SYMBOLS
Here is a quick explanation of our safety symbols for you and
your doctor. These symbols appear next to certain medications in
this member guide:
Means to weigh risk of birth defects or other adverse outcomes.
Means do not use in pregnancy.
Means plan allows coverage of diabetic supplies at nocharge.
Note: This information is in effect at the time of printing and is
subject to change.

THERAPEUTIC DRUG CATEGORIES
ANTI-INFECTIVES (Antibiotics/Antifungals)
Oral Penicillins
Oral Cephalosporins
Oral Tetracyclines
Select generics used to treat diabetes, CHF, high blood pressure, high cholesterol, and brand-name and generic smoking deterrents.
Select generics and select brand-name medications used to treat diabetes,CHF, high blood pressure, and high cholesterol.
Select brand names used to treat diabetes, CHF, high blood pressure, andhigh cholesterol AND brand-name medications used to treat other healthconditions.
Select generics and other brand-name medications. For personal choice brand-name medicationsMeans weigh risk of birth defects or other adverse outcomes.
Means do not use in pregnancy.
Oral Erythromycins
Oral Sulfas
Oral Urinary Tract
Oral Quinolones
Oral Antifungal
Select generics used to treat diabetes, CHF, high blood pressure, high cholesterol, and brand-name and generic smoking deterrents.
Select generics and select brand-name medications used to treat diabetes,CHF, high blood pressure, and high cholesterol.
Select brand names used to treat diabetes, CHF, high blood pressure, andhigh cholesterol AND brand-name medications used to treat other healthconditions.
Select generics and other brand-name medications. For personal choice brand-name medicationsMeans weigh risk of birth defects or other adverse outcomes.
Means do not use in pregnancy.
PSYCHOTHERAPEUTICS (Anxiety/Depression)
Hypnotic Agents
Tricyclic
Antidepressants
Miscellaneous
Antidepressants
Select generics used to treat diabetes, CHF, high blood pressure, high cholesterol, and brand-name and generic smoking deterrents.
Select generics and select brand-name medications used to treat diabetes,CHF, high blood pressure, and high cholesterol.
Select brand names used to treat diabetes, CHF, high blood pressure, andhigh cholesterol AND brand-name medications used to treat other healthconditions.
Select generics and other brand-name medications. For personal choice brand-name medicationsMeans weigh risk of birth defects or other adverse outcomes.
Means do not use in pregnancy.
Anxiolytics
Antipsychotics
Antidepressants
Select generics used to treat diabetes, CHF, high blood pressure, high cholesterol, and brand-name and generic smoking deterrents.
Select generics and select brand-name medications used to treat diabetes,CHF, high blood pressure, and high cholesterol.
Select brand names used to treat diabetes, CHF, high blood pressure, andhigh cholesterol AND brand-name medications used to treat other healthconditions.
Select generics and other brand-name medications. For personal choice brand-name medicationsMeans weigh risk of birth defects or other adverse outcomes.
Means do not use in pregnancy.
SSRI Antidepressants
Miscellaneous
Psychotherapeutic
aspartate/amphetamine sulfate/dextroamphetamine Select generics used to treat diabetes, CHF, high blood pressure, high cholesterol, and brand-name and generic smoking deterrents.
Select generics and select brand-name medications used to treat diabetes,CHF, high blood pressure, and high cholesterol.
Select brand names used to treat diabetes, CHF, high blood pressure, andhigh cholesterol AND brand-name medications used to treat other healthconditions.
Select generics and other brand-name medications. For personal choice brand-name medicationsMeans weigh risk of birth defects or other adverse outcomes.
Means do not use in pregnancy.
CARDIOVASCULAR
(Blood Pressure/Heart/Cholesterol)
Beta Blockers
Dihydropyridines
Nitroglycerin Patches
Calcium Blockers
Select generics used to treat diabetes, CHF, high blood pressure, high cholesterol, and brand-name and generic smoking deterrents.
Select generics and select brand-name medications used to treat diabetes,CHF, high blood pressure, and high cholesterol.
Select brand names used to treat diabetes, CHF, high blood pressure, andhigh cholesterol AND brand-name medications used to treat other healthconditions.
Select generics and other brand-name medications. For personal choice brand-name medicationsMeans weigh risk of birth defects or other adverse outcomes.
Means do not use in pregnancy.
Adrenergic
Antagonists &
Related Drugs
Antilipidemics
Angiotensin II
Blockers & Renin
Inhibitors
Select generics used to treat diabetes, CHF, high blood pressure, high cholesterol, and brand-name and generic smoking deterrents.
Select generics and select brand-name medications used to treat diabetes,CHF, high blood pressure, and high cholesterol.
Select brand names used to treat diabetes, CHF, high blood pressure, andhigh cholesterol AND brand-name medications used to treat other healthconditions.
Select generics and other brand-name medications. For personal choice brand-name medicationsMeans weigh risk of birth defects or other adverse outcomes.
Means do not use in pregnancy.
Combination
Antihypertensives
ACE Inhibitors
Select generics used to treat diabetes, CHF, high blood pressure, high cholesterol, and brand-name and generic smoking deterrents.
Select generics and select brand-name medications used to treat diabetes,CHF, high blood pressure, and high cholesterol.
Select brand names used to treat diabetes, CHF, high blood pressure, andhigh cholesterol AND brand-name medications used to treat other healthconditions.
Select generics and other brand-name medications. For personal choice brand-name medicationsMeans weigh risk of birth defects or other adverse outcomes.
Means do not use in pregnancy.
ENDOCRINE (Diabetes/Hormones/Contraceptives)
Insulin Therapy
Non-Insulin
Hypoglycemic Agents
Select generics used to treat diabetes, CHF, high blood pressure, high cholesterol, and brand-name and generic smoking deterrents.
Select generics and select brand-name medications used to treat diabetes,CHF, high blood pressure, and high cholesterol.
Select brand names used to treat diabetes, CHF, high blood pressure, andhigh cholesterol AND brand-name medications used to treat other healthconditions.
Select generics and other brand-name medications. For personal choice brand-name medicationsMeans weigh risk of birth defects or other adverse outcomes.
Means do not use in pregnancy.
Blood Glucose Test
Contraceptive Agents
* Means plan allows coverage of diabetic supplies at no charge Select generics used to treat diabetes, CHF, high blood pressure, high cholesterol, and brand-name and generic smoking deterrents.
Select generics and select brand-name medications used to treat diabetes,CHF, high blood pressure, and high cholesterol.
Select brand names used to treat diabetes, CHF, high blood pressure, andhigh cholesterol AND brand-name medications used to treat other healthconditions.
Select generics and other brand-name medications. For personal choice brand-name medicationsMeans weigh risk of birth defects or other adverse outcomes.
Means do not use in pregnancy.
Estrogens/Estrogen
Combinations
Select generics used to treat diabetes, CHF, high blood pressure, high cholesterol, and brand-name and generic smoking deterrents.
Select generics and select brand-name medications used to treat diabetes,CHF, high blood pressure, and high cholesterol.
Select brand names used to treat diabetes, CHF, high blood pressure, andhigh cholesterol AND brand-name medications used to treat other healthconditions.
Select generics and other brand-name medications. For personal choice brand-name medicationsMeans weigh risk of birth defects or other adverse outcomes.
Means do not use in pregnancy.
G I (Ulcer)
Ulcer Drugs
Select generics used to treat diabetes, CHF, high blood pressure, high cholesterol, and brand-name and generic smoking deterrents.
Select generics and select brand-name medications used to treat diabetes,CHF, high blood pressure, and high cholesterol.
Select brand names used to treat diabetes, CHF, high blood pressure, andhigh cholesterol AND brand-name medications used to treat other healthconditions.
Select generics and other brand-name medications. For personal choice brand-name medicationsMeans weigh risk of birth defects or other adverse outcomes.
Means do not use in pregnancy.
NSAIDS (Pain Relievers)
DRUGS TO TREAT OVERACTIVE BLADDER
Select generics used to treat diabetes, CHF, high blood pressure, high cholesterol, and brand-name and generic smoking deterrents.
Select generics and select brand-name medications used to treat diabetes,CHF, high blood pressure, and high cholesterol.
Select brand names used to treat diabetes, CHF, high blood pressure, andhigh cholesterol AND brand-name medications used to treat other healthconditions.
Select generics and other brand-name medications. For personal choice brand-name medicationsMeans weigh risk of birth defects or other adverse outcomes.
Means do not use in pregnancy.
RESPIRATORY (Allergy/Asthma)
Beta Agonists Oral
Beta Agonist Inhalers
Nasal Corticosteroids
Miscellaneous
Pulmonary Agents
Inhaled Steroids
Select generics used to treat diabetes, CHF, high blood pressure, high cholesterol, and brand-name and generic smoking deterrents.
Select generics and select brand-name medications used to treat diabetes,CHF, high blood pressure, and high cholesterol.
Select brand names used to treat diabetes, CHF, high blood pressure, andhigh cholesterol AND brand-name medications used to treat other healthconditions.
Select generics and other brand-name medications. For personal choice brand-name medicationsMeans weigh risk of birth defects or other adverse outcomes.
Means do not use in pregnancy.
OSTEOPOROSIS/PAGET’S DISEASE
Select generics used to treat diabetes, CHF, high blood pressure, high cholesterol, and brand-name and generic smoking deterrents.
Select generics and select brand-name medications used to treat diabetes,CHF, high blood pressure, and high cholesterol.
Select brand names used to treat diabetes, CHF, high blood pressure, andhigh cholesterol AND brand-name medications used to treat other healthconditions.
Select generics and other brand-name medications. For personal choice brand-name medicationsMeans weigh risk of birth defects or other adverse outcomes.
Means do not use in pregnancy.
NEUROLOGICALS
Anticonvulsants/
Anti-Seizure
Select generics used to treat diabetes, CHF, high blood pressure, high cholesterol, and brand-name and generic smoking deterrents.
Select generics and select brand-name medications used to treat diabetes,CHF, high blood pressure, and high cholesterol.
Select brand names used to treat diabetes, CHF, high blood pressure, andhigh cholesterol AND brand-name medications used to treat other healthconditions.
Select generics and other brand-name medications. For personal choice brand-name medicationsMeans weigh risk of birth defects or other adverse outcomes.
Means do not use in pregnancy.
Migraine/Headache
Drugs to treat
Alzheimers Disease
Select generics used to treat diabetes, CHF, high blood pressure, high cholesterol, and brand-name and generic smoking deterrents.
Select generics and select brand-name medications used to treat diabetes,CHF, high blood pressure, and high cholesterol.
Select brand names used to treat diabetes, CHF, high blood pressure, andhigh cholesterol AND brand-name medications used to treat other healthconditions.
Select generics and other brand-name medications. For personal choice brand-name medicationsMeans weigh risk of birth defects or other adverse outcomes.
Means do not use in pregnancy.
This guide does not contain a complete list of formulary and nonformulary drugs. It only liststhe most commonly prescribed drugs. For anupdated and complete listing of your prescriptionbenefit, you can visit the “Benefit highlights” section of our website, Express-Scripts.com, and click on “Learn about formularies” or by callingcustomer service at the phone number on theback of your prescription card. Express Scripts and Medco have come together as one company, soMedco is now a part of the Express Scripts family of pharmacies.
2013 Express Scripts Holding Company.
All rights reserved.

Source: http://www.hr.emory.edu/eu/docs/express-scripts-member-guide.pdf

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