Outpatient Prescription Drug Coverage
Express Scripts administers your outpatient prescription drug benefit for all of the Group Medical Plan Options (BCBSAL, Aetna, and the HMO and POS plans) except:
- Kaiser Permanente of California;
- Kaiser Health Plan of Colorado;
- Kaiser Health Plan of Georgia;
- Kaiser Health Plan of Oregon; and
- Kaiser of the Mid Atlantic.
These Kaiser HMO plans currently administer their own prescription drug program. Employees enrolled in these Kaiser HMO plans should consult their HMO booklet or carrier for more information regarding the exclusions and limitations for their prescription drug coverage.
The Express Scripts outpatient drug benefit plan provides you with prescription drugs:
- Conveniently, through local pharmacies, mail order, or the Internet;
- Cost effectively; and
- With your safety in mind.
As the nation's largest independent manager of pharmacy benefits, Express Scripts manages the prescription needs of one of every six people in the United States.
If you enrolled timely in the Group Medical Plan Options, Express Scripts will mail a welcome packet to your home in time to receive prescription benefits on your first day of eligibility. It contains information describing how to use the program, a list of preferred medicines, a list of nearby pharmacies, a mail-order form, and ID cards.You can obtain additional information through the Express Scripts web site, accessible via the employee portal at www.myloweslife.com (My Lowe's Life > My Health > Health Related Quick Links > Prescription Plan (for all plans except Kaiser)).
You can also order replacement ID cards or print an ID through the Express Scripts web site, accessible via the employee portal at www.myloweslife.com (My Lowe's Life > My Health > Health Related Quick Links > Prescription Plan (for all plans except Kaiser)). You can also find a temporary ID card on the employee portal at www.myloweslife.com (My Lowe's Life > My Health > Health Related Quick Links > Prescription Plan Temporary ID).
Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Lowe's Companies, Inc. and prescription drug coverage available for people with Medicare. It also explains the options you have under Medicare prescription drug coverage and can help you decide whether or not you want to enroll. At the end of this notice is information about where you can get help to make decisions about your prescription drug coverage.
- Medicare prescription drug coverage became available in 2006 to everyone with Medicare through Medicare prescription drug plans and Medicare Advantage Plans that offer prescription drug coverage. All Medicare prescription drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.
- Lowe's Companies, Inc. has determined that the prescription drug coverage offered by the Lowe's Welfare Plan is, on average for all plan participants, expected to pay out as much as the standard Medicare prescription drug coverage will pay and is considered Creditable Coverage.
Because your existing coverage is on average at least as good as standard Medicare prescription drug coverage, you can keep this coverage and not pay extra if you later decide to enroll in Medicare prescription drug coverage.
Individuals can enroll in a Medicare prescription drug plan when they first become eligible for Medicare and each year from November 15th through December 31st. Beneficiaries leaving employer/union coverage may be eligible for a Special Enrollment Period to sign up for a Medicare prescription drug plan.
You should compare your current coverage, including which drugs are covered, with the coverage and cost of the plans offering Medicare prescription drug coverage in your area.
If you decide to enroll in a Medicare prescription drug plan and drop your Lowe's Companies, Inc. prescription drug coverage, be aware that you and your dependents may not be able to get back your Lowe's prescription drug coverage.
Please contact us for more information about what happens to your coverage if you enroll in a Medicare prescription drug plan.
See the remainder of this section for an explanation of the prescription drug coverage plan provisions/options under the Group Medical Plan Options (except Kaiser medical plan options) that Medicare eligible individuals have available to them when they become eligible for Medicare Part D. Kaiser medical plan participants should refer to their Kaiser HMO Book and Certificate for information about their prescription drug benefits.
You should also know that if you drop or lose your coverage with Lowe's Companies, Inc. and don't enroll in Medicare prescription drug coverage after your current coverage ends, you may pay more (a penalty) to enroll in Medicare prescription drug coverage later.
Contact HR Shared Services at 1-888-HRINFO5. NOTE: You will receive this notice annually and at other times in the future such as before the next period you can enroll in Medicare prescription drug coverage, and if this coverage through Lowe's Companies, Inc. changes. You also may request a copy.
More detailed information about Medicare plans that offer prescription drug coverage is in the "Medicare & You" handbook. You'll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare prescription drug plans. For more information about Medicare prescription drug plans:
- Visit www.medicare.gov
- Call your State Health Insurance Assistance Program (see your copy of the Medicare & You handbook for their telephone number) for personalized help,
- Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
For people with limited income and resources, extra help paying for Medicare prescription drug coverage is available. Information about this extra help is available from the Social Security Administration (SSA) online at www.socialsecurity.gov, or you can call them at 1-800-772-1213 (TTY 1-800-325-0778).
Remember: Keep this notice. If you enroll in one of the new plans approved by Medicare which offer prescription drug coverage, you may be required to provide a copy of this notice when you join to show that you are not required to pay a higher premium amount.
The following comparison highlights the prescription drug benefits offered under the Copay 500, Copay 750, and most HMO options of the Group Medical Plan Option.
Lowe's currently utilizes a 5-tier design. Tier 1 is all generic products. Tiers 2 & 3 include products that are on the ESI National Preferred Formulary. Tiers 4 & 5 are not on the ESI National Preferred formulary and will result in the highest copay.
The tiers are defined as follows:
- Tier 1-Generic Products - This tier will afford you the lowest copay while allowing for the same clinical effects as its branded name counterpart
- Tier 2-Formulary Products with no generic alternatives in the same drug class and Specialty Products - This tier is reserved for formulary products that are used when a unique treatment is required for a certain disease state. There are only about 150 products on this tier. In these cases, there are no generics available in the class that will obtain the same result. Some examples of these disease states include osteoporosis, inflammatory bowel, cancer, etc. The ESI National Preferred Formulary document will have the symbol  in front of all products that are on this tier.
- Tier 3-Formulary Products that are not on Tier 2
- Tier 4-Non-Formulary Products
- Tier 5-Non-Formulary Products for classes of drugs where there are significant generic or over-the-counter (OTC) alternatives (i.e., non-sedating antihistamines, proton pump inhibitors (PPIs), sedative hypnotics and overactive bladder).
Maintenance medications are prescription drugs you take on a regular basis to treat chronic medical conditions like heart disease, high blood pressure and high cholesterol. A list of maintenance medications is available on the employee portal at www.myloweslife.com (My Lowe's Life > My Health > Health Related Quick Links > Express Scripts Maintenance Medication List).
Filling your maintenance medication prescriptions through home delivery saves you time and money. It also helps Lowe's control the drug costs of the Group Medical Plan.
For all medical plan options except Kaiser, all new prescriptions written for maintenance medications must be filled through home delivery or you will pay the full price of the drug when purchased at a retail pharmacy. You will be allowed two courtesy refills at a retail pharmacy before being charged the full price of the drug.
Express Scripts offers Group Medical Plan Option participants one of the largest networks of participating pharmacies available with over 53,000 nationwide. It includes both national chains and independent retailers. To find a retail pharmacy participating in the Express Scripts network:
- Refer to the list of nearby pharmacies in the packet mailed to your home with your ID cards;
- Go to www.express-scripts.com, select member services, then pharmacy locator; or
- Call the toll-free customer service number listed on your ID card.
The list of preferred medicines covered by your Group Medical Plan Option is called the formulary. An expert panel of physicians and pharmacists has carefully reviewed all of the medicines on the formulary for safety, quality, effectiveness, and cost. The formulary also includes generic drugs, which the Federal Drug Administration approves as bioequivalent, meaning they perform in your body the same way as a brand-name drug. When appropriate, your doctor should use the formulary to prescribe drugs for you.
To find out whether a particular medicine is included on your formulary, visit the Express Scripts web site, accessible via the employee portal at www.myloweslife.com (My Lowe's Life > My Health > Health Related Quick Links > Prescription Plan (for all plans except Kaiser)). Additionally, all participating retail pharmacies receive the formulary, so you also can ask your pharmacist to check whether your prescribed medicine is on the formulary.
Mail Service Pharmacy: Ask your doctor to write a prescription for a 90 day supply, plus refills for up to one year. If you need to begin the medicine immediately, ask your doctor for a second prescription for a 30 day supply and take it to a participating pharmacy. A separate copay will apply for each prescription.
To begin mail service, complete the member profile on the form included in your ESI packet. (You only need to complete the profile once. If you need additional forms, call the toll-free customer service number on your ID card). Be sure to include your ID number and your prescription in the envelope.
Express Scripts, mail service pharmacy will ship your medication within 48 hours of receipt. Your medication will be delivered free of shipping costs within two weeks. Overnight or second-day delivery may be available for your area for an additional charge. Along with your medication, you will receive a form to remind you when to order your refill.
Online Pharmacy: To order your medication online:
- To order your medication online, visit the Express Scripts web site, accessible via the employee portal at www.myloweslife.com (My Lowe's Life > My Health > Health Related Quick Links > Prescription Plan (for all plans except Kaiser)), then
- Select member services;
- Select fill new prescriptions or order refills; and
- Provide the required information.
The Express Scripts secure website protects both your personal and financial privacy. Express Scripts does not disclose or sell any information about you to another party without your permission.
Unless additional information is needed, Express Scripts will ship your medication within 48 hours of your submitting the request online. Your medication will be delivered free of shipping costs within two weeks. Overnight or second-day delivery may be available for your area for an additional charge. Along with your medication, you will receive a form to remind you when to order your refill.
Retail Pharmacy: Take your prescription and Express Scripts ID card to the nearest participating pharmacy. To find one:
- Refer to the list in the Express Scripts packet;
- Go to www.express-scripts.com select member services, then pharmacy locator; or
- Call the toll-free customer service number listed on your ID card (1-877-586-3116).
The participating pharmacist will verify your eligibility in the system. Then, the system will determine the Copay amount and the pharmacist will request payment.
That's it! You don't have to file a claim with the network manager, wait for further reimbursement, or check an explanation of benefits statement.
Specialty Pharmacy: Express Scripts will handle your specialty medication needs through CuraScript, and specialty prescriptions will be processed through the CuraScript Pharmacy.
Just like with mail service, your medication comes to you free of shipping costs and arrives within two weeks of ordering it online (standard delivery only; overnight or second-day delivery may be available for your area with an additional charge). If you need your medication right away, ask your doctor to write a prescription up to a 30-day supply for you to fill at a participating retail pharmacy, and then order your refills online. Separate Copays will apply.
Medications which can only be filled through the Specialty Pharmacy Program include the following specialty medication categories:
- Anticoagulant (i.e., Lovenox)
- Endocrine Disorder (i.e., DAP, Octreotide, etc.)
- Enzyme Deficiency (i.e., Cerezyme, Elaprase, etc.)
- Growth Hormone Deficiency
- Immune Deficiency
- Inflammatory Conditions (i.e., Enbrel, Remicade, etc.)
- Iron Toxicity
- Multiple Sclerosis
- Organ Transplant
- Osteoarthritis (i.e., Euflexxa)
- Pulmonary Hypertension
- Respiratory Conditions (i.e., Aralast, TOBI, Xolair, etc.)
This list is not all inclusive and is subject to change as new drugs are introduced.
When using the CuraScript Specialty Pharmacy you will have:
- Free Delivery of medication to your home or alternate address of your choice;
- Direct Pharmacist and Nurse Access through CuraScript provides convenient access to an experienced clinical care management team who will ensure you receive continual, prompt personalized care while on treatment;
- Educational Materials, support and/or home instructions information
- Ancillary Supplies such as syringes and needles at no additional cost;
- Comprehensive Coordination of Care including refills, reminders and continual interaction with your physician in regard to your medication(s).
How to order your specific injectable medications:
- To begin using CuraScript and to transfer into the CuraScript Specialty Pharmacy Program, your physician will need to call 1-866-848-9870 and request a Patient Enrollment Form. Once CuraScript receives your prescription information, they will contact you to arrange for the applicable Copayment and expedited delivery of your medication. If you have any questions regarding your injectable pharmacy benefit, please contact the CuraScript Pharmacy Customer Service Department toll-free at 1-866-848-9870, Monday through Friday, 8:00 a.m. – 9:00 p.m. EST, or Saturday, 9:00 a.m. – 1:00 p.m. EST.
When you use a nonparticipating pharmacy, you must pay the full retail cost for your prescription and then submit a claim for reimbursement to Express Scripts. Express Scripts will reimburse you for the contracted price, minus the Copay amount for your Copay Option.
You can request a claim form by calling the toll-free customer service number on your ID card or obtain the form online. Along with the prescription-drug claim form, you will need:
- A receipt for your prescription; and
- The National Drug Code (NDC) number for your prescription from the pharmacist.
Before your Group Medical Plan Option will cover some medications, prior authorization may be required. If the pharmacist tells you that your prescription requires this, ask the pharmacist or your doctor to call the toll-free number on your ID card for instructions. See "Prior Authorization Review" in the section "Additional Prescription Drug Benefits" for more details.
- Comparison of Copay Options
- Other Important Information
- Plan Overviews
- Group Medical Plan
- Dependent Eligibility
- Filing Claims
- Outpatient Prescription Drug Coverage
- Additional Prescription Drug Benefits
- Cost Sharing
- Continuation of Coverage for Dependents of Deceased Employees
- Early Retiree Health Plan (Continuation of Group Health Benefits)
- Coverage Under an HMO or POS Option