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Prescription Drug Program

The Windstream medical plan includes prescription drug coverage. Both medical and prescription drug payments count toward meeting your deductible and out-of-pocket maximum. 

Prescription Plan Rates 


Drug Category Coinsurance Rates

The Consumer 6300 plan does not have a coinsurance phase. 

Filling a Prescription

When you fill a prescription, you pay the retail price until you reach your deductible. Both medical and pharmacy expenses count toward meeting your deductible. After meeting your deductible, you pay your coinsurance rate until you reach the out-of-pocket maximum at which time Windstream pays 100% of the prescription cost.

You may fill up to a 30-day supply at a retail pharmacy and up to a 90-day supply via home delivery (mail order). Maintenance medications must be filled via home delivery after two orders have been filled at a retail pharmacy. An additional $10 charge is added if the retail prescription is filled at a non-network pharmacy. The pharmacy network includes retailers such as Wal-Mart, K-Mart, Kroger, Target, Costco, Safeway, Albertsons, and Rite-Aid.

A Note About Generics

Before you fill a prescription ask your doctor about your options. Generic prescriptions are usually less expensive than a name-brand medication. You should also consult with your pharmacist about the cost, as many retailers offer generic discount programs that may save you more. 

All prescription costs filed with your insurance card will apply toward meeting your deductible.

You can research the cost of prescriptions by logging into your Express Scripts account at

Prescription Terms you need to know 

GenericA generic drug is identical--or bioequivalent--to a brand name drug in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use.  Although generic drugs are chemically identical to their branded counterparts, they are typically sold at substantial discounts from the branded price. 

FormularyA drug formulary is a list of preferred prescription drugs, that offer the greatest overall value and is preferred by your insurance plan. You will pay more if you and your doctor choose a medication that is not covered on your health plan’s formulary. You can review the formulary list at

Brand Formulary A brand name formulary prescription is included in the preferred formulary, but is more expensive than generic alternatives. 

Specialty MedicationMedications which require special dosing or administration, are typically prescribed by a specialist and are more expensive than most medications. They may include biosimilar specialty drugs. 


Home Delivery Service for Maintenance Medications

Participants are required to purchase maintenance medications through mail order. You can obtain your original prescription plus one refill per maintenance medication prescription at a local retail pharmacy. After two refills at your local pharmacy, you will need to submit a 90-day prescription request to Express Scripts to begin using the Home Delivery service. Mail order must be used for maintenance medications for all Windstream medical plans.

If your medication is not on the Maintenance Medication list, you may obtain it at retail pharmacy. The Maintenance Medication list, which is updated periodically, can be found at You can also call Care Coordinators by Quantum Health at 877.550.3255 for the most updated list.

Generic Medication

Generic drugs, when available, are the most cost effective purchasing decision for Windstream as a whole and for you individually, and many therapy classes have a range of cost-effective generic options. When a brand name drug becomes available as a generic, by law, the generic drugs must meet the same standards for safety, purity, strength and quality. These generics are considered to be chemically equivalent to the brand name drug.

Prior Authorization

Certain prescription drugs require prior authorization to confirm appropriateness of treatment. The prescribing physician should call Express Scripts before submission to the pharmacy to avoid delays and to expedite the authorization process. The list of medications requiring prior authorization is published by Express Scripts and available at

Step Therapy

Step Therapy is a drug protocol management tool used to ensure appropriate drug therapies for certain conditions. The Step Therapy program recommends using a less expensive treatment that is known to be safe and effective for most people – referred to as a first-line drug – prior to using a more expensive drug for the same condition. The Express Scripts system will alert your pharmacist that your medication requires prior authorization if you are trying to fill a prescription for a drug that is not identified as a first- line drug within a class that requires step therapy. If this occurs, you will need to contact your physician to either switch to a first-line drug or have your physician call Express Scripts for information on how to obtain a prior authorization for a second-line drug.

Specialty Medication

If you are using a specialty medication, you may fill it at a retail pharmacy initially. After that, you will need to order your medication through Accredo, Express Scripts’ specialty pharmacy. Specialty medications are those used for chronic or complex disease states such as: Hepatitis, Multiple Sclerosis, Growth Hormone Deficiency, Rheumatoid Arthritis, Infertility, Hemophilia, and Oncology.


Only maintenance drugs purchased through the Windstream Plan must use mail order. Although the retail store may provide prescription information to Express Scripts, you always have the option of purchasing your prescriptions using Express Scripts or through a retail discount program. Ask your pharmacist which option is most affordable.

Brand Exclusions

The Brand Exclusion program targets brand name medications that are not available as a generic. Instead, these brands have therapeutically equivalent generic alternatives available. Therapeutically equivalent means that these medications can be expected to produce essentially the same therapeutic outcomes. Brand exclusions are in place in the following therapy classes. If you choose a brand-name drug, you will be responsible for the full cost of the prescription even if you have met your deductible. Generic options are covered under the plan.

In rare circumstances, use of the brand name may be medically necessary for treatment. In those cases, your physician may request a prior authorization by calling ExpressScripts at 877.559.0155.