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MIT Employee Benefits

Important

The Prescription Drug Benefit is a provision of the BCBS and Tufts health plans. If you belong to either the Traditional MIT Health Plan or the Flexible MIT Health Plan, you have access to MIT Pharmacy. Read more about the prescription drug provisions of the Traditional MIT Health Plan and Flexible MIT Health Plan.

Eligibility

You are eligible for the Prescription Drug Benefit if you are paid by MIT, are appointed to work at MIT for at least three months, work at least 50% of the normal full-time work schedule, and are enrolled in any of MIT's health plans.  MORE

Next steps

1. Confirm your eligibility.
2. Review prescription drug benefit details.
3. Locate a participating pharmacy (Step 2 on the Express Scripts web page).

Details

The Prescription Drug Benefit

You and your eligible family members are automatically enrolled in a prescription drug plan managed by Express Scripts (ESI) when you sign up for MIT health coverage through either Blue Cross Blue Shield (BCBS) or Tufts Health Plan. The benefit provides a variety of cost savings for eligible prescription drug expenses when they are prescribed by a BCBS or Tufts Health Plan doctor. You can obtain your medications by mail or at retail pharmacies that belong to your health plan's network.

• When you use an ESI network pharmacy, you can purchase up to a 30-day supply of your medications.
• When you order through the mail, you can order up to a 90-day supply of your medications.

Preview the Prescription Drug Benefit

Through the Express Preview site you can

• Estimate your out-of-pocket prescription drug costs.
• Review the details of your Prescription Drug Benefit.
• Search for participating pharmacies.
• View list of drugs covered by the Plan.

Traditional MIT Health Plan and Flexible MIT Health Plan members:

Read more about the prescription drug provisions of the Traditional MIT Health Plan and Flexible MIT Health Plan.

Who is eligible

• you have been appointed—and are currently employed—to work at MIT for at least three months
• you work at least 50% of the normal full-time work schedule
• you are paid by MIT
• you are enrolled in either a Blue Cross Blue Shield or Tufts Health Plan through MIT

Who is NOT eligible

• contractor
• affiliate
• teaching or research assistant
• honorary lecturer
• summer appointment
• international visiting student
• member of the armed services assigned to MIT
• family member who is not employed by MIT
• work-study student
• paid by MITemps

Members of collective bargaining units

All the plan provisions are subject to the terms of your collective bargaining agreement.

How it works

If you are eligible for the Prescription Drug Benefit, Express Scripts (ESI) will send you an ESI ID card automatically. The amount you save depends on

• how you fill your prescription—by mail or through an ESI network retail pharmacy
• which tier of drug you purchase
  • Tier 1 drugs—Generic
    Medications that have exactly the same active ingredients as their brand-name counterparts. Your costs will be lowest when you choose Tier 1 drugs.
  • Tier 2 drugs—Preferred brand
    Brand-name medications that are on a list of preferred drugs (also referred to as the Preferred Formulary List (PDF)) that have been approved by a panel of doctors and pharmacists as safe, effective, and less expensive than other alternatives. You will pay more for Tier 2 drugs than Tier 1 drugs.
  • Tier 3 drugs—Non-preferred brand
    Brand-name medications that have not been identified as an effective, lower cost medication on the formulary list. Your costs will be highest when you choose Tier 3 drugs.

Your cost

Use the table below to determine your cost or copayment.

Filling your prescriptions by mail

The Express Scripts (ESI) mail service pharmacy provides

• home delivery of your prescription medications, including the option for automatic refills
• patient education materials
• toll-free phone consultation with patient-care advocates and registered pharmacists

Use ESI's Home Delivery Guide (PDF) to fill your prescriptions by mail. Be sure to allow 14 days for the delivery of your first mail order. You can reach ESI's Patient Contact Center 24 hours a day, 365 days a year at (866) 454-7118.

Prescription drug programs

Some prescription drugs covered by the Pharmacy Benefit are subject to prior authorization, step therapy, or specialized management/coordination when they are prescribed for you.

• Prior Authorization—When prescribing a medication on the Prior Authorization Drug List (PDF), your doctor must contact Express Scripts at (800) 417-8164 to provide proof of medical necessity.
• Step Therapy—A variety of medications can be used to fulfill the same drug therapy or to treat the same condition. Step therapy is designed to ensure that you receive the safest, most effective, most affordable drug treatment by recommending use of equivalent generic drugs on the Step Therapy Drug List (PDF) before authorizing coverage for brand-name drugs. Contact Express Scripts at (800) 825-4879 for more information about Step Therapy.
• Specialty Medications—Medications on the Specialty Drug List (PDF) require consultation with a patient care coordinator. These medications are generally injectibles used to treat chronic medical conditions and typically range in cost from $1,000 per month/dose up to $15,000 per month/dose.The Pharmacy Benefit provides this care through the specialty pharmacy CuraScript. When you fill your specialty drug prescription through CuraScript, a coordinator will contact you to schedule delivery. Call CuraScript at (866) 848-9870 for more information.