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Posted on: January 26, 2023

Understand How Your Pharmacy Benefits Work

Pharmacy benefits

When enrolled in the City’s medical plan, you automatically have prescription drug coverage through SouthernScripts, our pharmacy benefit manager. 

The annual deductible is $100 per individual or family. This is the amount of money you pay out-of-pocket for covered prescriptions before SouthernScripts begins to pay. The deductible must be satisfied every calendar year before the coinsurance and copays apply. 

Understanding Tiers

  • Tier 1 includes only generic drugs and may only cost a minimal copay.
  • Tier 2 includes preferred brand-name drugs with a higher copay than Tier 1.
  • Tier 3 consists of non-preferred brand-name drugs with an even higher copay.
  • Specialty drugs are costly and generally associated with treatment for rare or serious medical conditions. 

Finding the Right Pharmacy 

  • Retail Pharmacies. Independent or chain outlets dispensing medications at retail prices; typically, in one-month supplies. Locate an in-network location under SouthernScripts member.
  • Retail and First Choice Pharmacies. Dispenses 90-day supplies of medications. Go to SouthernScripts website > Log in > “First Choice” icon.
  • Mail Order Pharmacies. Provide a three-month supply for the cost of a two-month supply delivered directly to your home. Get prescriptions through Postal Prescription Services (PPS) by filling out and returning a mail order form along with a doctor’s three-month prescription plus your payment. 

Money Saving Options for YouPrescription drug prices

If you’re managing a serious or chronic health condition, these are great options:

    Plano CRX International Mail Order Pharmacy – You pay $0 in copays and your medications are shipped to your house for FREE. 

  1. Check the formulary list to fine the medication (you must have tried the medication for at least 30 days)
  2. If the drug is listed, ask your doctor for a three-month prescription with three refills 
  3. Fill out the enrollment form
  4. Send Plano CRX the prescription, enrollment form and a copy of your driver’s license or other government issued ID
  5. CRX will call you to review the order before shipping to your home
  6. Refills are WORRY FREE. Plano CRX calls prior to each refill to ensure the supply is continuous 

    Plano CRx Specialty Pharmacy – Registered pharmacists and nurses are available 24/7 to help understand treatment regimes, discuss side effects, check for drug interactions, review lab results, manage medication supplies and coordinate care with your doctor. 

o    Contact CRx Specialties Solutions at 877-646-1716 or visit CRx to see if you qualify.

If you’re managing multiple medications:

    PillPack by Amazon – PillPack transfers existing prescriptions, conveniently packages them by day/time the drug should be taken and ships them to your doctor for FREE. 

o    Sign up online at pillpack.com

If you just want to save some money on your meds:

    Variable Copay Program – The program uses manufacturer coupons to significantly reduce the cost of eligible medications. 

Example of how the program works:

Drug: Humira
Retail Pharmacy copay - $100
Manufacturer coupon - $95
Your copay - $5

o    Contact CRx Specialties Solutions at 877-646-1716 or visit CRx to see if you qualify.

Visit the City's Benefits webpage for detailed information. For questions about medications, contact: 

SouthernScripts at 800-710-9341
Monday – Friday: 6:30 am - 8:00 pm
Saturday: 8 am - 5 pm
Sunday: 8 am - 4 pm

Contact HRBenefits@plano.gov for further assistance.

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