Pharmacy Benefits

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)