Traditional Pharmacy Benefits

Medication Adherence Program (MAP) For Retirees taking Diabetes and Cardiovascular Medications

*This applies to the Traditional 70/30 Plan and the Enhanced 80/20 Plan.

To make it easier for members to stay healthy and take their medications as directed by their provider, the State Health Plan is providing a special benefit to retired members taking medications for cholesterol, blood pressure and blood sugar. Retired members can order a 90-day supply of their diabetes and heart medications from a participating pharmacy for 2½ times the copay. Click here to see the list of participating pharmacies.

Click here to see the list of medications included in the program. If a member is taking one or more of these medications, they should consider receiving them from a participating pharmacy.

  Up to a 30-day supply 31-60 day supply 61-90 day supply Diabetes and Heart Medication 61-90 day supply from participating pharmacies
Tier 1*
$12 $24 $36 $30
Tier 2
$40 $80 $120 $100
Tier 3
$64 $128 $192 $160
Brand name drug, with a generic available
Tier 1 copay + the difference between the Plan's cost of the brand name drug and the Plan's cost of the generic drug, not to exceed $100 per 30-day supply. $30 generic copay + difference

*If a generic is included on the Low Cost Generic list it will continue to be $10 for a 90-day supply.

Savings: Members can save money by receiving up to a 90-day supply for just one lower copayment.

Example: The copay for Januvia, a diabetes medication, is $40 (Tier 2) for a 30-day supply. If Januvia is obtained through this program, it would be $100 for a 90-day supply, with an annual savings of $80.

Automatic Refills: Members may schedule automatic refills of important medications. For mail order, members may opt into this program and would receive a phone call prior to their automatic refill and shipment of the medication. Ask about this option at participating retail pharmacies.

Extended payment plan (mail order only): This allows members to pay for a 90-day supply of a medication over time instead of all at once.

To get started with this program, or if you have questions, call Express Scripts Member Service at at 800-336-5933.

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