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.
Sandia has partnered with Express Scripts (BCBSNM or UHC members) for a program called "Smart90". Under Smart90 retail or mail order program, members must fill their 90-day prescriptions at a Walgreens or through mail order.
In-Network* |
Out-of-Network |
|
Prescription Drugs Retail (Maximum 30-day supply) | ||
Generic | You pay 20% |
You pay 50% |
Brand-Name Preferred | You pay 30% |
You pay 50% |
Brand-Name Non-Preferred |
You pay 40% |
You pay 50% |
Prescription Drugs Mail Order (Maximum 90-day supply) | ||
Generic | You pay 20% |
n/a |
Brand-Name Preferred | You pay 30% |
n/a |
Brand-Name Non-Preferred |
You pay 40% |
n/a |
There is an annual out-of-pocket maximum of $1,500 per person for in-network prescription drugs. | There is no out-of-pocket maximum for out-of-network prescription drugs. | |
*There is no difference between the prescription drug benefits associated with the Sandia HPN and the in-network benefits. |
Express Scripts Customer Service
Phone 1-877-817-1440 1-800-759-1089 (TTY) |
Hours 24 hours/7 days a week |
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Website To learn more about Express Scripts, you may register online at www.express-scripts.com. Select "For Members" and follow instructions to register. |
Kaiser Member Services Call Center
Phone 1-800-464-4000 |
Hours M-F 7a-7p, Sat-Sun 7a-3p |
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Website www.kponline.org |
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.
Plan members who have primary prescription drug coverage under another group health care plan are not eligible to use the Mail-Order Program or to purchase drugs from retail network pharmacies at the copayment level.