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Division of Human Resources

New prescription benefits

The South Carolina Public Employee Benefit Authority (PEBA) and Express Scripts—the company awarded the contract to administer the State Health Plan prescription drug benefit effective January 1, 2016—are working hard to make sure you get the medications you need conveniently and at the lowest possible cost.

Members should have received a welcome packet from Express Scripts that included a new prescription drug identification card. Members should present this card to their pharmacy beginning January 1, 2016, to ensure their benefit is processed accurately.

Physicians and pharmacists continually review and compare the medications on a pharmacy network’s formulary, which is the network’s list of preferred drugs, including new drugs and generics. As a result, some safe and effective drugs become “preferred” and others may become “non-preferred.”

What are “preferred” and “non-preferred” medications?

  • Preferred, or formulary, medications are effective medications that are similar to non-preferred medications. This list of drugs is determined based on the advice of pharmacists and a group of independent doctors. Preferred medications cost less than non-preferred medications. Members should review the formulary list [pdf] for the State Health Plan, effective January 1, 2016. Please note: Not all drugs on the list are covered by all prescription plans and the enclosed list might not show every covered drug.
  • Non-preferred, or non-formulary, medications are those medications not on the State Health Plan’s list of recommended drugs and therefore may cost you more.

If you currently are prescribed a drug that is not on the preferred list, we encourage you to talk with your doctor about prescribing preferred drugs that are on the formulary list. Doing this can save you money and using generic drugs may save you even more.

Individualized formulary disruption letters were mailed to Medicare Prescription Drug program subscribers identified as being impacted by a change December 29, 2015. Letters to affected commercial (non-Medicare) subscribers are scheduled to be mailed January 5, 2016. Subscribers should allow up to five days for delivery.

If you have any questions about Express Scripts or changes in the formulary, you may contact Express Scripts at 855-612-3128.

Posted January 5, 2016

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