Your Health:

Prescription Drug

Introduction

Marathon Petroleum’s prescription drug coverage for both Health Plan options is administered by Express Scripts. You will automatically receive prescription drug coverage if you enroll in either Health Plan option.

Prescription Drug – Overview

Your prescription drug costs will depend on the Health Plan option you elect, whether you purchase at a retail pharmacy or through mail order, and the type of prescription drugs you buy (i.e., generic or brand name). The plan also covers certain preventive drugs and immunizations at 100% when obtained in-network. All prescription and specialty drugs MUST be purchased through Express Scripts mail order pharmacy or at a participating network pharmacy, or there will be no coverage from the plan.

Retail Overview

For retail medications, your prescriptions must be filled at an Express Scripts network pharmacy.

Generally, you should use retail pharmacies to purchase up to 30-day supplies of new prescriptions or medications you expect to take on a short-term basis. Ninety-day supply programs are more cost effective for both you and the Company, so the plan encourages appropriate use by limiting the number of 30-day fills of a maintenance drug. To encourage the use of mail order or Smart90-Walgreens, there will be no coverage for the 3rd and subsequent fills of a maintenance drug not purchased through one of these 90 day supply options. You will pay 100% of the cost of the medication. The amount you pay will not be applied to your deductible or out-of-pocket maximum.

Mail Order Overview

If you take medications on an ongoing basis for chronic conditions, they are classified as maintenance drugs and you should purchase a 90-day supply from the Express Scripts mail order pharmacy.

If your doctor is prescribing a maintenance drug, you should ask for two prescriptions – one for a 30-day supply to fill at retail (so you can start your medication right away) and one for a 90-day supply with three refills.

Smart90-Walgreens Overview

As an alternative to the mail order pharmacy from Express Scripts described above, you can choose to get your maintenance medications supplied through a Walgreens pharmacy. The document below has details regarding this program that may answer some of your questions.

Prescription Drug Coverage Chart

Prescription Drugs – All Options
  Classic Option Saver HSA Option
Out-of-Pocket Maximum Combined with medical
Prescription Annual Deductible Retail Only — $100 Individual; $200 Family Combined with medical

Retail (30-day supply):

  • Generic Drugs
  • Preferred Brand Drugs3
  • Non-Preferred Brand Drugs3

 

  • $10 after deductible2
  • $30 after deductible2
  • $60 after deductible2
You pay 20% after deductible1

Maintenance Drugs4 – 3rd and subsequent fills

You pay 100%5 You pay 100%5

Mail Order (90-day supply):

  • Generic Drugs
  • Preferred Brand Drugs3
  • Non-Preferred Brand Drugs3

 

  • $252
  • $752
  • $1502
You pay 20% after deductible1

Smart90-Walgreens (90-day supply) retail deductible applies:

  • Generic Drugs
  • Preferred Brand Drugs3
  • Non-Preferred Brand Drugs3

 

  • $25 after deductible2
  • $75 after deductible2
  • $150 after deductible2
You pay 20% after deductible1

1 Certain generic preventive drugs under the Saver HSA option are covered at 100%. A list of these drugs can be found here.

2 If the total cost of a drug is less than the copay, your cost will be the total cost (e.g., if the total cost of a generic drug at retail is $4, you will pay $4 instead of the $10 copay).

3 If you purchase a brand-name drug when a generic is available, you will pay the cost of the generic drug plus 100% of the difference in price between the generic and brand-named drug.

4 To encourage the use of mail order or Smart90-Walgreens, there will be no coverage for the 3rd and subsequent fills of a “maintenance drug” purchased in 30-day supplies at a retail pharmacy. You will pay 100% of the cost of the medication.

5 The amount you pay will not be applied to your deductible or out-of-pocket maximum.

Preventive Drugs and Immunizations

Preventive Medications Covered Under Both Plan Options

The plan covers many preventive medications and immunizations at no cost to you when provided by or obtained through an Express Scripts in-network pharmacy. These include generic drugs and, in some cases, brand-named drugs, along with some over-the-counter (OTC) medications. However, for eligible OTC medications to be covered at 100%, you must have a prescription.

Drug List – Preventive Items and Services Offering - 2018
Medicine Category and Who is Covered Examples of Medicines Covered

Aspirin

  • Persons age < 70
Aspirin doses of 325mg and below (81mg)

Contraceptive Methods

  • (Only one of the available programs described is chosen for coverage by a prescription drug plan.)

Brand name contraceptives with a generic equivalent are zero cost share only when the prescriber indicates the brand product must be dispensed.

Expanded Product Program:

Covered products include all FDA-approved 16 contraceptive methods available through the prescription drug benefit, including: all OTC contraceptive methods (female condom, spermicides, etc.), all oral contraceptives (including emergency contraception), and all contraceptive devices (diaphragms, skin patch systems, injectable contraception, intrauterine systems, and implants).

Fluoride

  • Children age 6 months through 5 years
  • Fluoride Chewable or Drops ≤ 0.5 MG
  • Multivitamin/Fluoride (≤ 0.5 MG ) Chewable/Drops/Suspension

Folic Acid

  • Adults < 51 years
  • Folic Acid Tablet 0.4 MG and 0.8 MG
  • Prenatal Vitamins with Folic Acid (0.4 MG and 0.8 MG)

Immunizations

  • The age for coverage varies based on the vaccine product prescribed and recommendations by the U.S. Centers for Disease Control and Prevention

Covered immunizations include those that are routine vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention and that meet the US Food and Drug Administration approved indications for age and/or gender limitations. Coverage also includes non-routine immunizations as defined by ACIP.

Medications used to prepare for Colonoscopy

  • Adults ≥ 50 and ≤ 75 years of age
  • Limit of 2 prescriptions per year

    (Only one of the available programs described is chosen for coverage by a prescription drug plan.)

Generic Plus Brand Program:

Covered products include:

  • Bisacodyl;, Magnesium Citrate; Milk of Magnesia; and PEG 3350 Plus GoLytely; MoviPrep; OsmoPrep; Prepopik; and Suprep

Primary Prevention of Breast Cancer

  • Adults ≥ 35 years who meet criteria
  • Tamoxifen generic
  • Raloxifene generic (only for postmenopausal persons)
  • Soltamox Liquid

Statins

  • Adults ≥ 40 years and ≤ 75 years

Covered products are generic low to moderate dose statins:

  • Atorvastatin ≤ 20mg
  • Pravastatin ≤ 80mg
  • Fluvastatin ≤ 80mg
  • Rosuvastatin ≤ 10mg
  • Lovastatin ≤ 40 mg
  • Simvastatin ≤ 40mg

Trend Management Program “Option 2”:

All generic low/moderate dose statins only for members meeting CVD medical history and Rx risk factor requirements (using claims data). Option includes Co-Pay Review feature.

Tobacco Cessation

  • Adults 18 and older

    (Only one of the available programs [Options] described is chosen for coverage by a prescription drug plan.)
  • Zyban (Brand and Generic)
  • Chantix
  • Nicotine Products (Rx and OTC; Brand and Generic)

Smoking Cessation

All FDA approved products listed above are covered for a maximum of 180 days therapy per 365 days after which, the member is responsible for a usual co-payment amount

Vitamin D Supplements

  • Adults ≥ 65 years of age
  • Vitamin D 1,000 Units or less per dose unit
  • Vitamin D with Calcium (1,000 Units or less per dose unit)

Additional Preventive Medications Covered Under the Saver HSA Option

For employees who elect the Saver HSA Health Plan option, prescription drugs on the list below are covered at 100% by the plan regardless of deductible.

More Important Information