Prescriptions
Benefits Enrollment & Changes
You may enroll in benefits during your first 31 days of full-time employment. However, once elections have been submitted, you are unable to make changes even if you are still within your 31-day enrollment window. You may also make changes to current coverage within 31 days of the date you experience a qualified change in status or change coverage during the annual open enrollment period. Open Enrollment is typically held November 1 – 15 each year, and elections made during this period become effective January 1 of the next calendar year.
Sections
Provider Contact
Express Scripts
1.800.953.3379
External Links
Express Scripts
Prescription Drug Coverage / Express Scripts
Changes for 2026:
Starting 1/1/26, spouses eligible for medical coverage through their own employer are not eligible for coverage on the Maritz medical plan. Click HERE for details.
Weight loss medications (both GLP-1 and non-GLP-1s) will no longer be covered - Click HERE for details.
This change does not impact members taking GLP-1 drugs to manage diabetes
Addition of Noom program for those enrolled in the Maritz medical plan starting 1/1/26
Omada and Livongo programs are ending 12/31/25
Diabetic testing supplies are covered at 100%
Changes to the Express Scripts National Preferred Formulary Drug List for 2026
Copayments/Coinsurance
The member coinsurance amount for all drugs is subject to minimum and maximum amounts after the deductible has been waived or satisfied, except for medications on the ACA Preventive or Preventive Plus lists, or medications you receive through SavonSP. See the chart below, which is applicable for both Maritz medical plans.
|
|
Generic |
Preferred Brand |
Non-Preferred Brand |
|||
|
Coinsurance % |
20% |
30% |
40% |
|||
|
Min & Max Copays apply after deductible is satisfied or waived |
Retail (30 Days) |
Mail Order (90 days) |
Retail (30 Days) |
Mail Order (90 days) |
Retail (30 Days) |
Mail Order (90 days) |
|
Minimum Copayment |
$10 |
$25 |
$25 |
$60 |
$50 |
$125 |
|
Maximum Copayment |
$30 |
$75 |
$75 |
$180 |
$150 |
$375 |
If your medication is on the Preventive Plus list, in addition to waiving your deductible, you will pay the applicable coinsurance percentage listed above for your medication, subject to the minimums and maximums listed above.
If your medication is not on the Preventive Plus list, you will continue to pay 100% of the cost of your medication until your annual deductible is satisfied. However, once the deductible is satisfied, your cost will be 20% (generic), 30% (preferred brands), or 40% (non-preferred brands), subject to minimums and maximums.
If you have prescriptions filled through Accredo (Express Scripts’ Specialty drug pharmacy), you will need to satisfy your annual deductible before the plan will pay any portion of these medications, unless your medication is on the SaveonSP Drug list (see prior section called “SaveonSP Program” above).
If you do not qualify for any copay assistance programs and are struggling to pay for a full 90-day supply of home delivery medications, contact Accredo or Express Scripts to see if you are able to pay for your 90-day supply of medication in three monthly payments.
Please note that the value of manufacturer coupons does not count toward your deductible and out-of-pocket maximum. Only the amount you pay out of your own pocket, or from your HSA, will apply.
Vaccine coverage is included in your prescription coverage with Express Scripts in addition to your medical benefit with Cigna. This means you can receive your vaccines from an in-network pharmacy or doctor’s office. Covered vaccines include Flu (injectable and nasal), Pneumonia, Hepatitis, Zoster (shingles), COVID, HPV, Childhood Vaccines (MMR, etc.), Meningicoccal, Tetanus/Diphtheria/Pertussis, and Rabies (prior authorization required).
Patient Assurance Program for Certain Glucose-Lowering Medications:
The Express Scripts’ Patient Assurance Program sets copay limits on certain preferred brand glucose-lowering drugs and products at a $25 copay for up to a 31-day supply or $75 for a 90-day supply. Visit www.express-scripts.com to use the “Price a Medication” tool or call Express Scripts at 800.953.3379 for additional information about the Patient Assurance Program.
Preferred Formulary Changes for 2026:
Medications are added, removed, and changed from one tier level to another on the National Preferred formulary each year. To find out if there will be any medications you are currently receiving added or removed from the formulary, click here: 2026 National Preferred Formulary Medications (Note: this list is the standard formulary list for Express Scripts - it is not customized to each client’s plan design, so is not a guarantee of coverage. You will see weight loss medications on the formulary, but Maritz will no longer cover these medications after 12/31/25).
In certain instances, when Express Scripts has identified and excluded high-cost drugs with limited clinical value that have clinically appropriate, lower cost alternatives available, they will send a notice to anyone who is currently taking this medication to let you know it will no longer be covered.
Preventive Drugs Covered 100%
The Affordable Care Act (ACA) requires certain medications to be classified as Preventive Drugs and covered by the plan at 100% with no cost to the member, such as aspirin; contraceptives; certain immunizations; supplements such as folic acid, vitamin D, or prenatal vitamins; bowel preps; smoking cessation products; breast cancer preventive drugs (brand drugs Tamoxifen, Raloxifene, Soltamox or generic anastrozole and exemestane); HIV Pre-Exposure Prophylaxis antiretroviral therapy for those who meet high-risk criteria; and low-to-moderate doses of generic statins (cholesterol-lowering) drugs. Note: if you take a high dose generic or brand name version of a statin medication you will pay the standard coinsurance as described below.
Patient age, drug dosage type and strength criteria must be met for all of these medications. A coverage review must be requested by the patient or doctor and approved by Express Scripts for breast cancer preventive drugs, before $0 copay will be applied.
Deductible Waived For Certain Preventive Drugs
The deductible will be waived for most medications taken to treat the following conditions (Referred to as Preventive Plus):
The following anti-depressents: CELEXA (citalopram), fluvoxamine, LEXAPRO (escitalopram), PAXIL (paroxetine), PAXIL CR (paroxetine ER), PEXEVA, PROZAC (fluoxetine), PROZAC WEEKLY (fluoxetine), SARAFEM (fluoxetine), ZOLOFT (sertraline)
Asthma
Bone Disease and Fractures
Cavities
Colonoscopy Preparation
Diabetes
Insulin and Non-Insulin Medicines
Diabetic Supplies Including Syringes, Needles, and Lancets
Heart Disease and Stroke
Blood Thinner Medicines
Cholesterol Lowering Medicines
High Blood Pressure
Respiratory Syncytial Virus
Malaria
These medications are taken to prevent certain medical diagnoses from developing into more serious medical conditions such as heart disease or stroke. Medications to treat these diagnoses are not covered at 100%, as the ACA required preventive medications are; however, we are permitted to waive the annual deductible for these drugs.
To see if your medications are on the Preventive Plus Drug List, click here: 2026 Preventive Plus Drug List.
Livongo Diabetes and Hypertension Programs
The Livongo Diabetes and Hypertension programs are ending 12/31/25. Current members can keep their blood pressure or glucose monitor, but readings will no longer sync with the app after December 31. Members in the Livongo for Diabetes program can order testing supplies through January 31, 2026.
Starting 1/1/26, testing supplies will be covered at 100% through Express Scripts.
SaveonSP Program
Maritz partners with Express Scripts SaveonSP program to help members save money on certain specialty medications. If you participate in this program, approximately 150 select specialty medications will be free of charge ($0). These prescriptions will continue to be filled through Accredo, your existing specialty mail pharmacy. If you are currently taking or will be taking one of these medications, you are eligible to participate in this program.
Enrollment in the program is voluntary. Keep in mind that if you choose not to participate, you will be responsible for a significantly higher cost, which will not be applied to your deductible or out-of-pocket maximums.
Express Scripts will send a letter to all members who are currently receiving any prescriptions from Accredo that are included in the SaveonSP program, which will include information about the program and steps to enroll.
If you currently receive specialty medications through Accredo and want to see if they are part of this program, click here: SaveonSP Medications. Medications on this list highlighted in green will be newly added and those highlighted in red will be removed from SaveonSP as of January 1, 2026.
Scripta Program
Maritz partners with Scripta Insights to help lower your out-of-pocket prescription costs. When you enroll in our health plan, you are automatically enrolled with Scripta, which is completely free to you. Scripta also helps reduce our health plan costs, allowing us to keep the cost of benefits as low as possible for everyone.
Scripta reviews your recent prescriptions and suggests alternatives that are the same or clinically equivalent to your current medications that cost less on our health plan. If you have an opportunity to save, you’ll receive a Personalized Savings Report from Scripta with a list of lower-priced options to discuss with your doctor. Scripta’s only job is to give you and your doctor the information you need to make smarter health decisions. Your doctor knows best.
Only you can access your savings reports. Maritz does not have access to your reports or prescription information. Scripta is HIPAA compliant, so you can trust that your personal health data will remain private and protected.
For more information, see the Scripta FAQ located in PDFs section in the left-side column near the top of this page.
Mail Order Requirement
The plan requires most maintenance medications to be ordered through mail order/home delivery after the first three fills at the local pharmacy. On the fourth fill at the local pharmacy, the drug will be denied, and you will be charged full price. The cost you pay will not be applied to your deductible. Mail order/home delivery copays and coinsurance are based on a 90-day supply, so make sure your provider writes the prescription for a 90-day supply on each fill. Coinsurance is not prorated based on the quantity received if less than 90 days.
Step Therapy
Step Therapy rules apply to the plan, which means your doctor may need to prescribe a different covered medication for you, or to confirm you have already tried that medication in the past with unsuccessful results, before certain drugs will be approved for coverage.
Prior Authorization
Prior Authorization rules also apply to the plan, which means you must receive approval for certain medications. Your doctor would need to request approval from Express Scripts for these medications by providing specific answers about your medical diagnosis and other required information.
Injectable Drugs in Doctor’s Office
For certain injectable medications for which the doctor places an individual order for you to have injected in their office, the medication must be ordered through Express Scripts (or Accredo for specialty medications) instead of through Cigna’s pharmacy in order to be covered. If you will be receiving an injectable medication for which your doctor has to order for you to be administered in his/her office, contact Express Scripts or Cigna to ask if this is a medication that needs to be filled through Express Scripts. If your doctor has already requested the medication through Cigna and you receive a denial stating the medication is not covered, contact Express Scripts to ask if the medication is covered if ordered through them instead.
Gene Therapy Drugs
Gene therapy drugs must be ordered and processed through Cigna’s pharmacy as a medical claim instead of through Express Scripts’ pharmacy as a prescription claim in order to be covered.
Price a Medication
If you are already enrolled in the Maritz medical plan, to see your estimated out-of-pocket cost for the current year, or to determine if your medications are subject to mail order requirements, step therapy rules, or require prior authorization, go to www.express-scripts.com, log in, and select the Manage Prescriptions, then Price a Medication link.
To see your estimated costs for the next calendar year, or if you are not currently enrolled in the medical plan and want to look up your medications, visit the Express Scripts open enrollment site at www.express-scripts.com/Maritz. This site will be open throughout the calendar year so if you are a new employee, you can access the site to look up your medications prior to enrolling, too.
Save With Your HSA
Why not lower your costs even more by paying for your prescriptions with pre-tax dollars from your HSA? Estimate the amount you think you will be paying out of your pocket for prescriptions during the year, and also take into consideration that Maritz will be contributing to this account each quarter. If your estimate shows your costs will be higher than the amount Maritz contributes, make an election to contribute that additional amount into your HSA. As you get your prescriptions filled, simply show your HSA debit card at the pharmacy to pay for your medications or use the debit card when you place your mail order with Express Scripts Home Delivery. By paying for these expenses with pre-tax dollars, you can save approximately 20 – 40%, depending on your tax bracket. Refer to the Health Savings Account page of this website for additional details.