Summary Plan Description
Express Scripts Retail Pharmacy Program
The Express Scripts Retail Pharmacy Program is a nationwide network of major pharmacy chains and independent pharmacies. This program is best for short-term care when you need a prescription filled immediately:
- Find a participating retail pharmacy close to your home or work. Participating retail pharmacies generally display the Express Scripts decal. If you need assistance, please contact Carpenters Trusts.
- When you purchase a prescription, show your Express Scripts ID Card to the pharmacist.
- There is a copayment for each prescription or refill purchased from a participating retail pharmacy:
- $7 copayment for each generic prescription.
- $15 copayment for each brand-name prescription listed on the drug program formulary.
- $30 copayment for each brand-name prescription not listed on the drug program formulary.
- Prescription drugs are limited to a 30-day maximum supply.
You may be given a generic equivalent of the prescribed drug by your pharmacist when available and permissible under the law, unless your physician indicates otherwise.
If you purchase a prescription from a participating retail pharmacy but forget your Express Scripts ID Card, the pharmacist may be unable to authorize the purchase and may require you to pay full retail price. You must then submit an Express Scripts Prescription Drug Reimbursement/Coordination of Benefits Claim Form to Express Scripts. Express Scripts will reimburse you at 100 percent of the "average wholesale price" – the program's discounted price – less the appropriate copayment. Prescription forms are available from Carpenters Trusts at (800) 552-0635 or www.ctww.org.
The pharmacy program covers a limited number of over-the-counter (OTC) medications with a $0 copayment, when prescribed by your physician. The OTC medications must be recommended preventive care services under the Affordable Care Act (ACA). The covered OTC medications include:
- OTC aspirin (325mg and 81 mg) for cardiovascular disease for men and women.
- OTC folic acid supplements (.04 mg and 0.8 mg) for women who may become pregnant.
- OTC vitamin D for community dwelling adults age 65 or older at increased risk for falls.
- OTC iron supplements for children age 6 months through 12 months at risk for anemia.
- OTC bowel preparation agents for adults age 50 through 75.
For a current list of OTC medications that are covered by the ACA, contact Express Scripts at (800) 669-3897 or visit www.healthcare.gov/preventive-care-benefits.
The pharmacy program also covers the following items when covered under the preventive care guidelines of the ACA. These items have a $0 copayment:
- Certain contraceptives for women, when prescribed by a physician.
- Breast cancer prevention drugs subject to clinical criteria, when prescribed by a physician.
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