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Pharmacy benefit expanded for students and affiliates

October 27, 2009

What do you do if you need a prescription filled but you’re away from MIT? Maybe it’s school vacation, or you’re on an internship in New York, or it’s a Saturday night and an Urgent Care provider at MIT Medical just wrote a new prescription for you. Until now, you had to pay the full prescription cost at a retail pharmacy and then get reimbursed for some of that amount later.

Now, members of the MIT Student or Affiliate Extended Insurance Plans can use their new Blue Cross Blue Shield (BCBS) ID cards to fill prescriptions at most retail pharmacies with just a $25 co-payment-and no paperwork. Students and affiliates can go to a participating Express Scripts pharmacy such as CVS or Walgreens and present a BCBS card, and the pharmacy will submit their claim directly to Express Scripts.

Some important things to remember:

• Your $25 co-payment at Express Script pharmacies is higher than your $15 co-payment at the MIT Pharmacy, so you should still get your prescriptions at MIT whenever possible.
• You must obtain your prescriptions at the MIT Pharmacy or an Express Scripts pharmacy. You will no longer be reimbursed for any prescriptions you obtain elsewhere.
• The benefit through Express Scripts is limited to $1,000 per calendar year. Your total prescription benefit limit is still $3,500. The Express Scripts formulary (the list of drugs for which a health plan provides coverage) is different than the one used by MIT Medical and the MIT Health Plans. To be covered by the MIT Health Plan, any medications that aren’t on the Express Scripts formulary must be obtained through the MIT Pharmacy. You can see the Express Scripts formulary at http://www.bluecrossma.com/pharmacy.

The new pharmacy option also provides access to the Blue Cross Blue Shield network of specialty pharmacies, which provide medications used to treat certain complex conditions. For certain high-cost medications, they can be the most affordable option. Specialty pharmacies can also send injectable medications directly to your physician’s office.

This benefit change will be more convenient for patients, since paying up front for expensive medications can be a real burden. Also, MIT’s overall pharmacy costs should be lower, which will give the MIT Health Plans the flexibility to increase the pharmacy benefit or minimize premium increases in the future.