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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 must purchase a 90-day supply from the Express Scripts mail order pharmacy or at a Walgreens with the Smart90 Program.

To begin mail order of your maintenance medications, you will need to register with Express Scripts. Simply create an account on express-scripts.com or the Express Scripts mobile app. Once your account is created, you can refill and renew prescriptions, set up automatic refills, check your order status, print a new prescription ID card and more!

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 $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) 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

Smart90-Walgreens (90-day supply) 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 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 - 2023
Medicine Category and Who is Covered Examples of Medicines Covered

Aspirin

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

Contraceptive Methods

  • Persons < age 51 years

    (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 or generic is not available.

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.

Preferred Product Program with Step Therapy:

Covered products, available at no cost, include one or more Food and Drug Administration (FDA) approved “Preferred Products” from the 16 contraceptive methods available through the prescription drug benefit. The “Preferred Products” include: generic OTC spermicide and legend diaphragms; Today® contraceptive sponge; female condom; Femcap®; generic oral, transdermal and intramuscular hormonal methods; contraceptive ring; generic, OTC emergency contraceptives and ella®; the intrauterine systems Mirena® and Paragard®; and the intradermal agent, Nexplanon®. Step Therapy criteria are applied to select brand oral contraceptives. Zero-dollar coverage of a contraceptive not included as a “Preferred Product” is available after copayment review.

Preferred Product Program:

Covered products, available at no cost, include one or more Food and Drug Administration (FDA) approved “Preferred Products” from the 16 contraceptive methods available through the prescription drug benefit. The “Preferred Products” include: generic OTC spermicide and legend diaphragms; Today® contraceptive sponge; female condom; Femcap®; generic oral, transdermal and intramuscular hormonal methods; contraceptive ring; generic, OTC emergency contraceptives and ella®; the intrauterine systems Mirena® and Paragard®; and the intradermal agent, Nexplanon®. Zero-dollar coverage of a contraceptive not included as a “Preferred Product” is available after copayment review.

Fluoride

  • Persons 6 months through <17 years
  • Fluoride Chewable or Drops ≤ 1.0 MG generic
  • Multivitamin/Fluoride (≤ 1.0 MG )Chewable/Drops/Suspension generic

Folic Acid

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

HIV Prep

  • Persons of any age

    Only for members lacking a history of treatment for HIV (using claims data).
  • Emtricitabine / tenofovir disoproxil fumarate (TDF) generic - 200 mg / 300 mg dose only (Truvada brand is included only until the generic is available)
  • Option includes Co-Pay Exception Review feature

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

  • Persons ≥ 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 Only Program:

  • Bisacodyl;, Magnesium Citrate; Milk of Magnesia; and PEG 3350 generic

Generic Plus Brand Program:

Covered products include:

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

Primary Prevention of Breast Cancer

  • Persons ≥ 35 years who meet criteria

Co-Pay Exception Review only:

  • Tamoxifen generic; Raloxifene generic (only for postmenopausal persons); and Soltamox Liquid

Statins

  • Persons ≥ 40 years and ≤ 75 years

Covered products may include generic low to moderate dose statins:

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

Standard Program “Option 1”:

all generic low/moderate dose statins

Trend Management Program “Option 2”:

Select generic low/moderate dose statins only for members meeting CVD medical history and Rx risk factor requirements (using claims data).

Option includes Co-Pay Exception Review feature.

Tobacco Cessation

  • Persons 18 and older
  • 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.

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.

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