Prescription Drugs
Available for Full-Time and Part-Time Krispy Kremers
A spoonful of sugar can help the medicine go down. And so can the savings you experience with a Krispy Kreme prescription drug plan! Your coverage depends on the medical plan you elect.
Cigna Plans
If you’re enrolled in one of the Cigna plans (the Kreme Filled Open Access Plus (OAP) Plan, the Sprinkles HSA Plan or the Original HSA Plan), you receive prescription drug coverage through RxBenefits and Express Scripts. Most retail pharmacy chains participate in the network, but double-check before you go, to make sure you get the best rate. Out-of-network pharmacies require you to pay the whole cost of the drug at the time of purchase and submit a claim for partial reimbursement.
If you’re prescribed maintenance medications to treat a chronic condition, like high blood pressure, you can receive your prescriptions through either the Mail-Order Pharmacy Program or a retail pharmacy.
Questions? Check out the RxBenefits FAQ, or contact the RxBenefits Member Services team Monday–Friday, 7 a.m.–8 p.m. CT, by calling 800-334-8134 or emailing RxBenefits.
Kreme Filled OAP Plan
With the Kreme Filled OAP Plan, you pay a flat copay for your prescriptions. There’s no deductible to meet. If you hit your annual out-of-pocket maximum, the Plan will pay for your prescriptions at 100% through the end of the year.
| Retail Pharmacy (1–30-Day Supply) |
Retail Pharmacy for Maintenance Medications (31–90-Day Supply) |
Mail-Order Pharmacy for Maintenance Medications (31–90-Day Supply) |
|
|---|---|---|---|
| Generic Drugs | $15 | $38 | $38 |
| Preferred Brand-Name Drugs | $35 | $88 | $88 |
| Non-Preferred Brand-Name Drugs | $70 | $175 | $175 |
| Out-of-Pocket Maximum You’ll Pay Each Year* | $5,000 per individual / $10,000 per family | $5,000 per individual / $10,000 per family | $5,000 per individual / $10,000 per family |
*The calendar year out-of-pocket maximum applies to pharmacy and medical claims. Each individual family member must meet the individual out-of-pocket maximum, unless the family out-of-pocket maximum has been met by any two or more covered family members. Once met, your covered prescriptions are paid at 100%.
Original HSA Plan
If you’re enrolled in the Original HSA Plan, you pay nothing for your prescriptions after you meet your annual deductible. The deductible includes your medical costs.
| Retail Pharmacy (1–30-Day Supply) |
Retail Pharmacy for Maintenance Medications (31–90-Day Supply) |
Mail-Order Pharmacy for Maintenance Medications (31–90-Day Supply) |
|
|---|---|---|---|
| Annual Deductible (Includes Medical) | $6,500 per individual / $13,000 per family | $6,500 per individual / $13,000 per family | $6,500 per individual / $13,000 per family |
| Generic Drugs | $0 after deductible | $0 after deductible | $0 after deductible |
| Preferred Brand-Name Drugs | $0 after deductible | $0 after deductible | $0 after deductible |
| Non-Preferred Brand-Name Drugs | $0 after deductible | $0 after deductible | $0 after deductible |
| Out-of-Pocket Maximum You’ll Pay Each Year* | $6,500 per individual / $13,000 per family | $6,500 per individual / $13,000 per family | $6,500 per individual / $13,000 per family |
*The calendar year out-of-pocket maximum applies to pharmacy and medical claims. Each individual family member must meet the individual out-of-pocket maximum, unless the family out-of-pocket maximum has been met by any two or more covered family members. Once met, your covered prescriptions are paid at 100%.
Sprinkles HSA Plan
If you’re enrolled in the Sprinkles HSA Plan, you pay 25% of the cost of your prescriptions after you meet your annual deductible.
| Retail Pharmacy (1–30-Day Supply) |
Retail Pharmacy for Maintenance Medications (31–90-Day Supply) |
Mail-Order Pharmacy for Maintenance Medications (31–90-Day Supply) |
|
|---|---|---|---|
| Annual Deductible (Includes Medical) | $2,500 per individual / $5,000 per family | $2,500 per individual / $5,000 per family | $2,500 per individual / $5,000 per family |
| Generic Drugs | 25% after deductible | 25% after deductible | 25% after deductible |
| Preferred Brand-Name Drugs | 25% after deductible | 25% after deductible | 25% after deductible |
| Non-Preferred Brand-Name Drugs | 25% after deductible | 25% after deductible | 25% after deductible |
| Out-of-Pocket Maximum You’ll Pay Each Year* | $6,000 per individual / $12,000 per family | $6,000 per individual / $12,000 per family | $6,000 per individual / $12,000 per family |
*The calendar year out-of-pocket maximum applies to pharmacy and medical claims. Each individual family member must meet the individual out-of-pocket maximum, unless the family out-of-pocket maximum has been met by any two or more covered family members. Once met, your covered prescriptions are paid at 100%.
Mini Plan
If you’re enrolled in the Mini Plan, you have prescription drug coverage. You’ll save even more if you choose an Optum network pharmacy to receive your medication.
If you use an Optum network pharmacy, just present your card at the pharmacy counter to receive any applicable discounts. The plan will pay up to $5 for a generic prescription or $15 for a brand-name prescription, and you will be responsible for the rest.
If you use an out-of-network pharmacy, you will pay for your medication in full at the pharmacy and submit a claim for reimbursement.
To receive reimbursement, submit your receipt along with the prescription printout from the pharmacy that shows the name of the patient, the medication, the dosage, the date dispensed and the fee charged to: sbclaims@symetra.com.
Or, you can go to www.optum.com to register for a member account and submit the printout directly to Optum. Be sure to include your pharmacy group number on the claim form. You can find it next to the BIN and PCN numbers on your card.
You can expect to receive a check from Optum within 30 days.
Make your experience even sweeter—and save money—by downloading the Express Scripts mobile app.
Virtual Visits and Prescriptions
If you use ReviveHealth to supplement your medical care, you may be eligible to receive certain prescription medications at no cost to you. If your ReviveHealth doctor prescribes a covered medication, it will be processed and delivered to your home within three to five days. You’re eligible for one shipment per month with no copay.
Get a healthy sprinkling of savings by selecting generics whenever you can. Generic medications contain the same active ingredients as their brand-name counterparts but generally cost much less.
