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Friday, June 9, will be a remote workday for all DOE employees due to the unhealthy air quality. It will be a remote-instruction day for students scheduled to be in attendance.

Drug plan design

There are three “tiers” of drugs in the plan. What does that mean?

Every drug is classified as either a generic drug (Tier 1), a preferred brand drug (Tier 2) or a non-preferred brand drug (Tier 3).

Are the copayments different for each tier?

Yes. Here is a chart showing the copayments for each tier:

Category Tier Retail pharmacy (30-day supply) ESI home delivery service (90-day supply) Smart 90 Walgreens/Duane Reade retail network (90-day supply)
Generic 1 $5 $10 $10
Preferred brand (formulary) 2 $15 $30 $30
Non-preferred brand (not on formulary) 3 $35 $70 $70


Is there an annual maximum for copayments?

Yes. There is a maximum out-of-pocket expense of $1,000.00. After a family has reached the $1,000.00 in copayments, no further copayments will be collected except for those drugs obtained in Tier 3 where you are responsible for the appropriate copayment.

Please note: if you were in the Cost Care program, you would also be responsible for the ancillary charges as explained above.

What is a preferred brand (formulary) drug?

A formulary is a list of approved medications created by a committee of doctors and other health care professionals for your pharmacy benefit plan. The Express Scripts Preferred Formulary includes all generic drugs and select brand-name medications.

There is a preferred brand drug (Tier 2) for most medical conditions. If your physician prescribes a brand-name drug for your particular condition — either because there is no generic or there is a special reason your physician wants to use the branded drug — and if it is on this list, then you will pay the Tier 2 copayment.

What is a non-preferred (non-formulary) brand drug?

Any brand-name drug not listed on the formulary is considered a non-preferred drug (Tier 3). Your copayments are higher since there are more cost-effective alternatives that are on the formulary to treat your condition. You would continue to pay copayments after you reached the $1,000.00 maximum out-of-pocket if your physician prescribes Tier 3 drugs.

If I am currently using a non-preferred brand drug, how can I switch to a preferred or a generic drug?

Speak to your doctor about your medication and discuss the options. Then your doctor can choose a brand or generic from the preferred formulary list and either call-in or write you a new prescription.