Pharmacy Benefits

Enhanced Contraceptive Coverage

The co-payment will be waived for most contraceptive medications under all of Duke's medical plans. A listing of medications, implants, and IUDs is available here (this listing is subject to change).

Co-pay & Deductible at Retail Pharmacies (up to 34-day supply)*

An annual $100 deductible per person applies to short-term brand and non-formulary prescriptions filled at retail pharmacies. This deductible means each person covered by the medical plan must satisfy the $100 deductible for brand and non-formulary drugs purchased at a retail pharmacy before the plan begins to pay benefits under a co-pay structure. There is no deductible for generic drugs (except for Duke Basic*).

The retail co-pay structure for short-term medications and controlled substances is listed below:

• Generic – $15 or cost of the drug if less than $15 (no deductible)*
• Brand – $50 (after meeting annual $100 deductible per person)
• Non-formulary – $70 (after meeting annual $100 deductible per person)

After your third purchase of the same medication, your prescription is considered to be a long-term medication and you will pay a higher cost if you continue to purchase it at a retail pharmacy (controlled substances and compounded drugs are exempt). Specifically, you will pay 50% of the total cost of the prescription, subject to a minimum and maximum. The minimum is $15 (or cost of drug if less) for generic; $70 for brand; and $85 for non-formulary drugs. The maximum is $30 for generic; $165 for brand; and $180 for non-formulary drugs.

To avoid paying more for your long-term medications, fill 90-day prescriptions through the Express Scripts Mail Order Pharmacy or participating on-site Duke Pharmacies (see sidebar for links with detailed location and hours information). Reasons to consider using the mail order pharmacy or participating on-site Duke Pharmacies for long-term medications include reduced co-pays and a waiving of the $100 deductible for all plans except Duke Basic (see chart below for details).

Injectable fertility drugs are not reimbursed according to our standard pharmacy benefit, nor are they covered under all of the plans. Only those plans covering infertility services include coverage of these drugs. More information is available here.

Additional information about Duke's pharmacy benefits such as brand-name drugs on the Express Scripts formulary (a list of approved drugs) and frequently asked questions, is available here.

*Participants in the Duke Basic medical plan have an annual $100 deductible for all prescription drugs (except for certain contraceptive drugs) and are required to use the mail order program or participating on-site Duke Pharmacies after the third purchase of a long-term medication.

Co-pay at Express Scripts Mail Order Pharmacy or Participating On-Site Duke Pharmacies (90-day supply)

You will save time and money by filling your recurring, long-term medications through the mail order program or participating on-site Duke Pharmacies. Reasons to consider using the mail order pharmacy or participating on-site Duke Pharmacies for long-term medications include reduced co-pays and a waiving of the $100 deductible for all plans except Duke Basic (see chart below for details). Your prescription must be written for a 90-day supply because a prescription for less than 90 days will still be charged a 90-day co-payment.

Duke Basic participants have a $100 annual deductible per person for all prescriptions (except for certain contraceptive drugs) and are required to use mail order or Duke Pharmacies for long-term medications.

*The co-payment (50% of the total cost of the medication) will also be subject to the following minimum and maximum co-payments. The minimum is $15 (or cost of drug if less) for generic; $70 for brand; and $85 for non-formulary drugs. The maximum is $30 for generic, $165 for brand, and $180 for non-formulary drugs. This does not apply to Duke Basic participants, because they are required to use mail order or Duke Pharmacies for long-term medications.