The Sandia Total Health Prescription Plan offers reliable coverage for members enrolled in the Sandia Total Health plans. Members enrolled in the Sandia Total Health plan administered by BCBSNM and UHC are eligible for the Express Scripts Prescription Drug Program. Members enrolled in the Sandia Total Health plan administered by Kaiser will use the Kaiser pharmacy for prescription drug services.

• In order to receive coverage for specialty medications, BCBSNM and UHC members must purchase these drugs through the Express Scripts Specialty Pharmacy–Accredo. These drugs are delivered via mail order through Accredo. All specialty prescriptions will be limited to a 30 day supply and will be subject to the retail coinsurance/copay structure (e.g., 30% coinsurance with a $25 minimum copay and $40 maximum copay for a preferred brand drug).
• You must show your Express Scripts or Kaiser identification card at all retail network pharmacies. If you do not show your Express Scripts or Kaiser identification card upon purchase to identify you as a Sandia participant, you will not be eligible for any reimbursement.
• Maximum of 30-day supply at retail network and out-of-network retail pharmacies.
• Reimbursement for a paper claim submitted for purchases at in-network pharmacies will not be allowed (except for coordination of benefits).
• Prescription drug copayments and/or coinsurance do not apply to your annual deductible or medical out-of-pocket limit/maximum.
• If the actual cost of the prescription through the mail or at a retail network pharmacy is less than the copayment, you will only pay the actual cost.
• Under the Express Scripts Prescription program, unless your physician specifies that the prescription be dispensed as written, prescriptions will be filled with the least expensive acceptable generic equivalent when available and permissible by law.
• Under the UHC and BCBSNM program, you must ask for a 90-day prescription with refills in 90-day increments.
• Certain prescriptions will only be dispensed with an appropriate medical diagnosis through the prior authorization process. In addition, some drugs may be subject to step therapy protocol.