MESSA’s popular 5-Tier Rx prescription plan is available with our ABC and Choices medical plans. It offers a mix of copays and coinsurance and is available with mandatory mail.
Plan combinations
5-Tier Rx is available with the following plans:
ABC 1
ABC 2
ABC 2.5
ABC 3
$500/$1,000
$1,000/$2,000
$2,000/$4,000
Questions about a specific medication?
How 5-Tier Rx works
5-Tier Rx works differently depending on whether you have an ABC medical plan or a Choices medical plan.
MESSA ABC with 5-Tier Rx
With a MESSA ABC plan, you pay the full cost of your prescriptions until your deductible is fully paid. After you meet your deductible, you are responsible for prescription copays or coinsurance until you reach your out-of-pocket maximum.
| Types of medications | Up to 34-day supply | 90-day supply |
|---|---|---|
| An expanded list of preventive medications are covered 100% with no deductible. See the list. | No cost to you | No cost to you |
| Generic drugs Members pay the lowest copay for generics, making them the most cost-effective option for treatment. |
$10 copayment | $30 copayment |
| Preferred brand-name drugs Includes preferred brand-name drugs. These drugs are more expensive than generics. |
$40 copayment | $120 copayment |
| Nonpreferred brand-name drugs Includes brand-name drugs for which there’s either a generic alternative or a more cost-effective, preferred brand-name drug available. |
$80 copayment | $240 copayment |
| Preferred specialty drugs Includes generic and brand-name specialty drugs that are used to treat difficult health conditions. |
20% coinsurance with a maximum of $150 (up to a 30-day supply) |
Not available |
| Nonpreferred specialty drugs Includes nonpreferred brand-name specialty drugs that are used to treat difficult health conditions. Members pay more for nonpreferred specialty drugs because there are more cost-effective generic or preferred drugs available. |
20% coinsurance with a maximum of $300 (up to a 30-day supply) |
Not available |
Specialty medications are handled separately. Specialty drugs must be obtained by mail through Walgreens Specialty Pharmacy or select Walgreens retail pharmacies. If you obtain specialty medications from any other provider, you may be responsible for the total cost.
The initial quantity of select specialty drugs may be limited, and your cost will be reduced accordingly. Additional fills for specialty drugs are limited to a 30-day supply.
For information about drug coverage and medication options, check the 5-Tier Rx drug list.
Please note: The 5-Tier Rx drug list is updated monthly. Coverage details are subject to change without notice.
If you have questions about a prescription medication, you may:
- Call our Member Service Center at 800-336-0013
- Send us a secure message via your MyMESSA account
- Connect with us via live chat through your MyMESSA account or the MESSA app.
Copay vs. Coinsurance
A copay is a fixed amount you pay for a medication. Coinsurance is a percentage you pay based on the cost of the medication, with a set maximum amount.
More than 98% of prescriptions filled by MESSA members have flat-dollar copays of $10, $40 or $80.
Overall, more than 90% of drugs have a copay of just $10.
With some health plans, 5-Tier Rx is available with mandatory mail, which requires home delivery of long-term and 90-day prescriptions through Optum Rx. This helps keep your costs low with the convenience of getting your prescriptions mailed directly to you.
If your prescription plan does not include mandatory mail, you can still choose to have your prescriptions delivered using Optum Rx.
MESSA Choices with 5-Tier Rx
With a Choices plan, you pay copays or coinsurance depending on the medication until you reach your prescription out-of-pocket maximum.
| Types of medications | Up to 34-day supply | 90-day supply |
|---|---|---|
| Specific preventive medications mandated by federal law are covered 100%. | No cost to you | No cost to you |
| Generic drugs Members pay the lowest copay for generics, making them the most cost-effective option for treatment. |
$10 copayment | $30 copayment |
| Preferred brand-name drugs Includes preferred brand-name drugs. These drugs are more expensive than generics. |
$40 copayment | $120 copayment |
| Nonpreferred brand-name drugs Includes brand-name drugs for which there’s either a generic alternative or a more cost-effective, preferred brand-name drug available. |
$80 copayment | $240 copayment |
| Preferred specialty drugs Includes generic and brand-name specialty drugs that are used to treat difficult health conditions. |
20% coinsurance with a maximum of $150 (up to a 30-day supply) |
Not available |
| Nonpreferred specialty drugs Includes nonpreferred brand-name specialty drugs that are used to treat difficult health conditions. Members pay more for nonpreferred specialty drugs because there are more cost-effective generic or preferred drugs available. |
20% coinsurance with a maximum of $300 (up to a 30-day supply) |
Not available |
The initial quantity of select specialty drugs may be limited, and your cost will be reduced accordingly. Additional fills for specialty drugs are limited to a 30-day supply.
Please note: The 5-Tier Rx drug list is updated monthly. Coverage details are subject to change without notice.
- If you have questions about a prescription medication, please call our Member Service Center at 800-336-0013, send us a secure message via your MyMESSA account, or connect with us via live chat through your MyMESSA account or the MESSA app.
Copay vs. Coinsurance
A copay is a fixed amount you pay for a medication. Coinsurance is a percentage you pay based on the cost of the medication, with a set maximum amount.
More than 98% of prescriptions filled by MESSA members have flat-dollar copays of $10, $40 or $80.
Overall, more than 90% of drugs have a copay of just $10.
If your prescription plan does not include mandatory mail, you can still choose to have your prescriptions delivered using Optum Rx.
Frequently asked questions
- Prior authorization: To ensure compliance with FDA-approved safe prescribing guidelines, certain drugs require prior authorization. Your doctor must submit documentation to support the need for the prescription.
- Quantity limits: Require previous treatment with one or more preferred drugs before coverage is approved. This ensures all clinically sound and cost-effective treatment options are tried before more expensive drugs are prescribed.
- Step therapy: Limits the amount of medication that will be covered based on FDA guidelines for appropriate and safe use.
Copay vs. Coinsurance
A copay is a fixed amount you pay for a medication. Coinsurance is a percentage you pay based on the cost of the medication, with a set maximum amount.
More than 98% of prescriptions filled by MESSA members have flat-dollar copays of $10, $40 or $80.
Overall, more than 90% of drugs have a copay of just $10.
Yes. While a plan that includes mandatory mail requires long-term prescriptions to be delivered, all MESSA members can choose to have their medications delivered using Optum Rx.
MESSA uses Optum Rx Home Delivery Pharmacy.
Standard shipping is free with Optum Rx. If you need medication more quickly, there is an expedited shipping fee.
Do you have additional questions?
We care about making it easier to understand and use your MESSA benefits. If you have questions about 5-Tier Rx, we’re here to help.
- Call our Member Service Center at 800-336-0013.
- Live chat with a member service specialist on your MyMESSA member account or the MESSA app.
- Send us a secure message in your MyMESSA account.
- Connect with your local MESSA field representative at 866-637-0006.