Pharmacy Benefits

Important Message from PEEHIP: Opposition to proposed Pharmacy Benefit Manager (PBM) legislation

Click here to see RSA's memo as to why RSA opposes this legislation and how it could affect you.

Click here to view a fact sheet about the PBM legislation as it relates to PEEHIP.

PEEHIP's Pharmacy Benefits are administered by Express Scripts for PEEHIP's Active Members and Non-Medicare-Eligible Retirees who are enrolled in the PEEHIP Blue Cross Blue Shield Group #14000 Hospital Medical Plan.

• Express Scripts Contact Information
• Information about prescription drugs and medications is located in the PEEHIP Hospital Medical Plan section of your Member Handbook (Active Members and Non-Medicare-Eligible Retirees). 
• Express Scripts Prescription Drug Lookup and Pharmacy Locator
• Express Scripts administers PEEHIP's specialty drug pharmacy program. Click here for a list of all in-network specialty pharmacies.

Formulary Drug List

Other Pharmacy Benefit Information

• Express Scripts At-Home COVID Test Reimbursement Form
• VIVA Health At-Home COVID Test Reimbursement Form
• Express Scripts Prescription Drug Reimbursement Form
• Flu Shots
• PEEHIP's Pharmacy Benefits are administered by UnitedHealthcare for PEEHIP's Medicare-eligible Retirees.

Prescription Benefit Copays Administered by Express Scripts

Tier 1 - Generic:

• $6 copay (1-30 day supply)
• $12 copay (31-90 day supply)

Tier 2 - Formulary (preferred brand name):

• $40 copay (1-30 day supply)
• $80 copay (31-60 day supply)
• $120 copay (61-90 day supply)

Tier 3 - Non-formulary (non-preferred brand name):

• $60 copay (1-30 day supply)
• $120 copay (31-60 day supply)
• $180 copay (61-90 day supply)

Tier 4 - Specialty Drugs

• 20% coinsurance per prescription, with a minimum of $100 copay and maximum of $150 copay (1-30 day supply)
• Days supplies greater than 30 are not allowed for specialty drugs (31-60 day supply)
• Days supplies greater than 30 are not allowed for specialty drugs (61-90 day supply)