Health Pool Pharmacy Program

Important Notices:

Prescription Drug Benefit Summary:

  • No Calendar Year Benefit Limit
  • $200 Annual Deductible for Plans I, II & III
  • $500 Annual Deductible for Plan IV
  • $1,450 Annual Deductible for High Deductible Health Plan/
    HSA-Qualified Plan V

 I.  Retail Pharmacy Copays (up to a 30-day supply)

  • Generics………………….$10
  • Formulary Brands………$25 (plus cost difference if generic available)
  • Non-Formulary Brands..$40 or 50% of the cost of the drug, whichever is greater
    (plus cost difference if generic available)

Trusted Tablets online pharmacy offers low cost for generic medications. Some of them is not covered by medical insurance but the prices are considerably lower in comparison with offline retail services. It is affordable to buy medications online. You are welcome to choose the right pharmacy store.
 II.  Medco Mail Order Pharmacy Copays (up to 90-day supply)

  • Generics…………………. $25
  • Formulary Brands……… $60 (plus cost difference if generic available)
  • Non-Formulary Brands…$100 or 50% of the cost of the drug, whichever is greater
    (plus the cost difference if generic is available)

III.  Specialty Medication Medication Copays:  $100  (30-day supply)

  • Specialty Medications are prescription drugs that cost $500 or more per dose, or $6,000 or more per year,* and have one or more of the following characteristics:
  • Complex therapy for complex disease
  • Specialized patient training and coordination of care (services, supplies, or devices) required prior to therapy initiation and/or during therapy
  • Unique patient compliance and safety monitoring requirements
  • Unique requirements for handling, shipping, and storage
  • Potential for significant waste due to the high cost of the drug

*Exceptions to the price threshold may exist based on certain characteristics of the drug or therapy which will still require the drug to be classified as a specialty drug. In addition, a follow-on biologic or generic product will be considered a specialty drug if the innovator drug is a specialty drug.

Specialty Drug List link:  Specialty Medications

  • Certain specialty medications are covered by the Pool only when they are provided through the Pool’s pharmacy benefit, by Express-Scripts–Medco/Accredo.  These medications consist of all hemophilia factor, growth hormone medications, and medications to treat metabolic disorders.


  • The outpatient prescription drug benefit is not available to a Pool enrollee who is also eligible for Medicare.
  •  $1,500 annual cap on copayments for HSA-Qualified Plan V.


Express Scripts administers the Pool’s outpatient prescription drug benefit.  If you have any questions
about your prescriptions, please call Express Scripts customer service at:


Manage Your Drug Benefit at
Tip: When registering, enter only
your 9-digit numeric ID# in the
Member Number field

Prescription Drug Benefit Handbook —  Regular Plans

Prescription Drug Benefit Handbook — HSAQ Plan

Pool Drug Formulary

 Pharmacy Chain Network

  Retail Prescription Claim Form

Specialty Medications List

Prior Authorization Drug List

Contact Express Scripts by telephone at