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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 - 2024
Medicine Category and Who is Covered Examples of Medicines Covered

Aspirin

  • Persons of any age
Generic, single-entity aspirin 81 mg

Includes copay exception review process

Breast Cancer – Primary Prevention

  • Persons ≥ 35 years who meet criteria.

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

Preferred Option: Copay Exception Review only:

Brand and generic tamoxifen (tablet, liquid solution); and for post-menopausal persons: raloxifene, anastrozole, and exemestane

Non-Preferred Option:

Generic tamoxifen, raloxifene, anastrozole, exemestane, and brand Soltamox are all covered at POS for $0 member-share without review. For other products not covered at $0 cost-share at the point of service, a memberor prescriber-initiated copay exception review is available.

Contraceptive Methods

  • Persons of any age capable of pregnancy

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

Brand name contraceptives with a generic equivalent are $0 cost share only when the prescriber indicates the brand product must be dispensed or generic is not available.

Expanded Product Option*:

Covered products include all FDA-approved 16 contraceptive methods available through the pharmacy benefit, including: OTC contraceptive methods (condoms, spermicides, etc.), oral contraceptives (including emergency contraception), and contraceptive devices.

Preferred Product with Step Therapy Option*:

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 pharmacy benefit. The “Preferred Products” include: generic OTC spermicide and legend diaphragms; Today® contraceptive sponge; condoms; Femcap®; generic oral, transdermal and intramuscular hormonal methods; contraceptive ring; generic, OTC emergency contraceptives; the intrauterine system Mirena®; and the intradermal agent, Nexplanon®. Step Therapy criteria are applied to select brand contraceptives.

Preferred Product Option*:

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 pharmacy benefit. The “Preferred Products” include: generic OTC spermicide and legend diaphragms; Today® contraceptive sponge; condoms; Femcap®; generic oral, transdermal and intramuscular hormonal methods; contraceptive ring; generic, OTC emergency contraceptives; the intrauterine system Mirena®; and the intradermal agent, Nexplanon®.

All options include copay exception review process.

*coverage of medications at $0 cost share is dependent on the list of medications covered by the member’s drug formulary.

Fluoride

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

Includes copay exception review process

Folic Acid

  • Persons of any age
  • Folic Acid Tablet 0.4 MG and 0.8 MG generic
  • Prenatal Vitamins with Folic Acid (0.4 MG and 0.8 MG) generic

Includes copay exception review process

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

Includes copay exception review process

Immunizations

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

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

Option 1:

Covered immunizations include those that are routine vaccines and non-routine immunizations 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 limitations.

Option 2:

This option only includes routine vaccines as defined by the ACIP.

Both options include copay exception review process.

Medications used to prepare for Colonoscopy

  • Persons ≥ 45 and ≤ 75 years of age Limit of 2 prescriptions per year; Package size limitations may apply

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

Generic Only Option:

Covered products include legend and over-the-counter medicines such as: Bisacodyl; Magnesium Citrate; Milk of Magnesia; and PEG 3350 generic.

Generic Plus Brand Option:

Covered products include the above listed generics plus select brands.

Both options include copay exception review process.

Statins

  • Persons ≥ 40 years and ≤ 75 years

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

Covered products may include generic low to moderate dose statins:

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

Standard Program Option 1:

generic low/moderate dose statins

Trend Management Program Option 2:

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

Both options include copay exception review process.

Tobacco Cessation

  • Persons 18 and older

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

Bupropion sustained release 150mg generic; Varenicline; and Nicotine

Smoking Cessation Option 1

All FDA approved products listed above are covered with no limitations.

Smoking Cessation Option 2

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 copayment amount.

Smoking Cessation Option 3

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 100% of the prescription cost.

Smoking Cessation Option 4

All Generic 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.

All options include copay exception review process.

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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