5-Tier Rx from MESSA
MESSA’s 5-Tier Rx prescription plan can save you up to 10% on the cost of your overall health plan premium while giving you access to essential medications — including many with a low $10 copay or no cost at all. This is a significant savings, allowing you to keep more of your health care dollars in your own pocket.
5-Tier Rx is available with our ABC and Choices medical plans. It offers a mix of copays and coinsurance and is available with mandatory mail.
As with all MESSA plans, 5-Tier Rx is subject to collective bargaining within your group.
Plan combinations
5-Tier Rx is available with the following plans:
ABC 1
ABC 2
ABC 2.5
ABC 3
Deductible options for individual/family
$500/$1,000
$1,000/$2,000
$2,000/$4,000
$3,000/$5,000
Mandatory mail
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.
Questions about a specific medication?
How 5-Tier Rx works
With 5-Tier Rx, prescription costs are broken down into copays for most medications and coinsurance for specialty medications. This structure makes it easy to budget your health care dollars. Here’s how the costs break down.
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
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.
Additional resources
Overview
Coverage booklet
Covered medications
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 |
Specialty medications
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.
Additional resources
Overview
Coverage booklet
Covered medications
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.
Learn more
For more information about 5-Tier Rx, call our Member Service Center at 800-336-0013 or connect with your local MESSA field representative at 800-292-4910, ext. 7817.