Prescription Drugs
Members of the Traditional and Flexible MIT Health Plans may use the MIT Pharmacy to fill prescriptions written by MIT Medical care providers or by an outside clinician if referred by an MIT Medical care provider. Using the MIT Pharmacy provides MIT Medical care providers with a complete picture of your prescription history, which allows them to better coordinate your medical care. If the MIT Pharmacy does not stock a covered medication, it can obtain it from an outside contracted pharmacy.
Prescriptions filled at the MIT Pharmacy have low copayments. You can obtain a 90-day supply of many prescriptions for the price of two 30-day refills. You can request refills by calling the Pharmacy at 617-253-0202 or by submitting a request online using Patient Online.
If you are out of the area or on nights and weekends when the pharmacy is closed, you can obtain up to a 30-day supply of most prescribed medications at any retail pharmacy in the Express Scripts network. Most major retail chains participate in this network. When using Express Scripts, you will have a higher copayment than at the MIT Pharmacy. Insurance coverage will be denied for some drugs purchased through Express Scripts even if those drugs are covered if obtained through the MIT Pharmacy, and the MIT Health Plan will not reimburse you if you choose to purchase these medications yourself.
To find an Express Scripts pharmacy or to see if your medications are included in the Express scripts formulary, visit the BCBSMA Pharmacy website. If you have questions about this coverage, contact Claims and Member Services at 617-253-5979.
The chart below details copays and limitations for the MIT Pharmacy and participating Express Scripts pharmacies:
| MIT Pharmacy copayment and limitations | Express Scripts copay and limitations | |
|---|---|---|
| Tier 1 copay | $8 for up to a 30-day supply | $15 for up to a 30-day supply |
| Tier 2 copay | $25 for up to a 30-day supply | $40 for up to a 30-day supply |
| Tier 3 copay | $40 for up to a 30-day supply | $50 for up to a 30-day supply |
| Supply limit | For many drugs, up to a 90-day supply for double the 30-day copayment |
Limited to a 30-day supply per fill |
| Prescribing physician |
Prescription must be written by an MIT clinician or by a provider to whom member was referred by an MIT clinician |
No restrictions |
| Mental health prescriptions | Member must notify MIT Medical, so a referral can be entered before prescription can be filled |
No restrictions |
| Mail order | Available through MIT Pharmacy; request can be submitted through Patient Online | Not available |
Note: MIT Health Plan members must fill all prescriptions at the MIT Pharmacy or at a participating Express Scripts pharmacy. There is no reimbursement for drugs purchased by the member. This includes prescription drugs not on the MIT Pharmacy or Express Scripts formularies.
MIT Flexible Plan members: Under the MIT Flexible Plan, benefits are available for out-of-network services, subject to a deductible and coinsurance. MIT Flexible Plan members who choose to see out-of-network providers may get their prescriptions filled only at participating Express Scripts pharmacies, and the copayment amounts listed above will apply. Effective January 1, 2008, prescription drug claims may no longer be used to satisfy the out-of-network deductible.
Updates:
Changes in drug coverage at MIT Pharmacy - Feb. 5, 2009
Resources
MIT Employee Health Plan
2010 MIT Traditional Health Plan brochure (PDF)
2010 MIT Flexible Health Plan brochure (PDF)
2009 MIT Traditional Health Plan brochure (PDF)
2009 MIT Flexible Health Plan brochure (PDF)
Related Links
Changes in drug coverage at MIT Pharmacy – Feb. 5, 2009
MIT Medical service directory
MIT Pharmacy
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