- Express Scripts is one of the largest pharmacy benefits managers and companies in the United States.
- The company offers Part D prescription drug plans in all 50 states, Puerto Rico, and Washington, D.C.
- Express Scripts offers three plans that vary in coverage and premium cost by state.
Medicare Part D is the portion of Medicare that provides prescription drug coverage. Medicare requires all participants have some form of prescription drug coverage.
Private insurance companies sell Medicare Part D plans. Sometimes they are a separate policy, while other times, they’re a part of a Medicare Advantage (Part C) plan.
Express Scripts offers prescription drug plans to Medicare beneficiaries who have original Medicare or Medicare Advantage plans without prescription drug coverage.
Keep reading to find out more about the Medicare Part D plans that Express Scripts offers, as well as how much you can expect to spend when choosing one of these plans in 2021.
Express Scripts is one of the largest pharmacy benefits managers and companies in the United States. As a very large company, Express Scripts negotiates with pharmacies and pharmaceutical companies to get low drug prices for its customers.
What do Express Scripts drug plans cover?
Each Express Scripts plan provides prescription drug coverage that includes a formulary of several thousands of medications that you would pay low to no cost for.
You have one of three choices for how to get your medications: preferred home delivery, preferred retail, or standard retail. You’ll usually save the most money by choosing the preferred home delivery option, which typically provides a 90-day supply for most medications.
Express Scripts “preferred network” includes retail pharmacies such as Walgreens and the Kroger family of pharmacies. Preferred retail is the mid-level cost option and offers a 30-day supply of your medications.
You’ll pay the most when getting medications from a standard retail pharmacy. Make sure your preferred pharmacy participates in the Express Scripts plan before you enroll. If not, you may need to choose another pharmacy or a different plan.
What states offer Express Scripts Part D plans?
Express Scripts offers its Part D plans in all states as well as Puerto Rico and Washington, D.C. The monthly premium for each of its plans and copay costs depend on where you live.
To view the plan options and monthly premiums in your area, you can use Medicare’s find a plan tool. With this online tool, you can enter your ZIP code and narrow the results to Express Scripts plans in your area.
Express Scripts offers three Part D plans: Saver, Value, and Choice. The average costs for each plan will vary based on where you live, but here are some basic difference of each plan:
- Express Scripts Medicare Saver. This plan has the lowest premium and also the lowest amount of medications on its formulary (covered medications list) compared to the other plans.
- Express Scripts Medicare Value. This plan is in the middle in terms of monthly premium for Express Scripts plans and has more options on it’s formulary.
- Express Scripts Medicare Choice. This plan has the most expensive monthly premium of the three Express Scripts plans, but also covers the most medications on its formulary.
All of the Express Scripts plans have a 3.5-star Medicare rating. Medicare rates plans on a scale of 5 stars. The score measures factors such as customer satisfaction, people leaving the plan each year, and customer service responsiveness.
Part D plans from Express Scripts vary in price based on the type of plan you choose and your location. The following tables offer some examples for comparison.
Express Scripts Medicare Saver costs
| Seattle, WA | Lincoln, NE | Norfolk, VA | |
|---|---|---|---|
| Monthly premium | $29.50 | $25.20 | $27.10 |
| Annual deductible | $285 | $285 | $285 |
| Total estimated annual cost | $354 | $302 | $325 |
| Tier 1 copay: preferred generic (30-day supply) | $2 | $2 | $2 |
| Tier 2 copay: generic (30-day supply) | $7 | $7 | $7 |
| Tier 3 copay: preferred brand (30-day supply) | $35 | $35 | $35 |
| Tier 4: nonpreferred brand (30-day supply) | 50% of cost | 50% of cost | 50% of cost |
| Tier 5: specialty (30-day supply) | 28% of cost | 28% of cost | 28% of cost |
Express Scripts Medicare Value costs
| Newark, NJ | Tampa, FL | Houston, TX | |
|---|---|---|---|
| Monthly premium | $32.30 | $26.80 | $16.80 |
| Annual deductible | $445 | $445 | $445 |
| Total estimated annual cost | $388 | $322 | $202 |
| Tier 1 copay: preferred generic (30-day supply) | $1 | $1 | $1 |
| Tier 2 copay: generic (30-day supply) | $3 | $3 | $3 |
| Tier 3 copay: preferred brand (30-day supply) | $24 | $30 | $42 |
| Tier 4: nonpreferred brand (30-day supply) | 49% of cost | 50% of cost | 50% of cost |
| Tier 5: specialty (30-day supply) | 25% of cost | 25% of cost | 25% of cost |
Express Scripts Medicare Choice costs
| Atlanta, GA | Sacramento, CA | Lansing, MI | |
|---|---|---|---|
| Monthly premium | $61 | $84.90 | $71.20 |
| Annual deductible | $100 | $100 | $100 |
| Total estimated annual cost | $732 | $1,019 | $854 |
| Tier 1 copay: preferred generic (30-day supply) | $2 | $2 | $2 |
| Tier 2 copay: generic (30-day supply) | $7 | $7 | $7 |
| Tier 3 copay: preferred brand (30-day supply) | $42 | $42 | $42 |
| Tier 4: nonpreferred brand (30-day supply) | 50% of cost | 49% of cost | 46% of cost |
| Tier 5: specialty (30-day supply) | 31% of cost | 31% of cost | 31% of cost |
Express Scripts offers Part D plans in nearly every area of the country. They utilize both mail-order and preferred retail pharmacies to provide savings to their customers.
To find out more about Express Scripts plans, costs, coverage, and formularies in your areas, check the company’s website here.