FSBP – Express Scripts Medicare Prescription Drug Plan (PDP) EGWP
A plan for FSBP Medicare-eligible members aged 65 and above
FSBP – Express Scripts Medicare Prescription Drug Plan (PDP) EGWP
The Foreign Service Benefit Plan (FSBP) offers an FSBP – Express Scripts Medicare Prescription Drug Plan (PDP) Employee Group Waiver Plan (EGWP) designed for FSBP Medicare-eligible members, age 65 and above, and eligible for Medicare Parts A and/or B.
This Plan offers significant prescription drug savings compared to your current prescription drug benefits while making no changes to your other benefits under FSBP. Your prescription drug benefits will continue to be administered by Express Scripts Inc. (ESI), and your new formulary will be identical to your current formulary. See below for a formulary comparison and savings chart.
| Prescription Coverage |
FSBP High Option Plan You Pay: | FSBP- Express Scripts Medicare Prescription Drug Plan You Pay: |
| Generic Drug (preferred, non-preferred, and non-formulary) | Retail 30-Day Supply: $10 copay Retail/Mail 90-Day Supply: $15 copay | Retail 30-Day Supply: $2 copay Retail/Mail 90-Day Supply: $4 copay |
| Preferred Brand Drug | Retail 30-Day Supply: 25% coinsurance ($30 minimum; $100 maximum) Retail/Mail 90-Day Supply: $60 copay | Retail 30-Day Supply: $40 copay Retail/Mail 90-Day Supply: $60 copay |
Non-Preferred and Non-Formulary Brand Drug | Retail 30-Day Supply: 35% coinsurance ($60 minimum; $200 maximum) Retail/Mail 90-Day Supply: 35% coinsurance ($80 minimum; $500 maximum) | Retail 30-Day Supply: $75 copay Retail/Mail 90-Day Supply: $150 copay |
| Specialty Drug | Retail/Mail 30-Day and 90-Day Supply: 25% coinsurance up to a maximum of $150 | Retail/Mail 30-Day and 90-Day Supply: 25% coinsurance up to a $150 maximum |
- How do I enroll or opt-in?
Effective January 2025 – You must choose to opt in to the program
We will no longer automatically enroll members when they become eligible; they must request to be enrolled. This change is in response to feedback from our members. Members already enrolled in PDP in 2024 will be automatically enrolled in 2025 and do not need to reenroll.
Eligible members can opt in scrolling down to complete the PDP form or by calling 202-833-4910 to speak with the enrollment team.
Call Express Scripts at 855-690-8353, 24 hours a day, 7 days a week, or go to www.express-scripts.com.
There are two (2) ways to opt out:
- Complete the online secure form below.
- Call FSBP at 202-833-4910, ask for Member Quality Services, Monday-Friday, 8:30am-5:30pm ET
If you opt out of the FSBP – Express Scripts Medicare PDP, you will revert back to the FSBP High Option Plan with your current prescription drug benefits.
Where one or more family members are Medicare eligible and one or more members are not, members may be enrolled in different Plans. Medicare-eligible dependents not enrolled in the FSBP – Aetna Medicare Advantage Plan will be enrolled in the FSBP – Express Scripts Medicare PDP. Non Medicare eligible dependents will remain enrolled in the FSBP High Option Plan.
No, there are no additional premiums for members enrolled in the PDP. The PDP is an enhancement of your prescription benefits under Section 5(f) of the FSBP Brochure.
Some members with higher incomes may be required to pay a Part D income related monthly adjustment amount, or D-IRMAA. The amount an individual may be required to pay will be based on their modified adjusted gross income (MAGI) reported on their income tax filing from two tax years earlier – e.g. 2022 income determines 2024 IRMAA. FSBP and Express Scripts cannot answer questions on your specific situation. You can find the IRMAA income bands and amounts on the following website: https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/monthly-premium-for-drug-plans.
No, enrolling or opting out of the PDP does not affect your enrollment in Part A or Part B of Medicare.
- Questions about PDP benefits?
If you have questions or if you would like to learn more about the FSBP – Express Scripts Medicare Prescription Drug Plan (PDP)?
Call Express Scripts at 855-690-8353, 24 hours a day, 7 days a week, or visit www.express-scripts.com.
Explore plan details to see if it's right for you
Forms & Resources
- FSBP – Express Scripts Medicare Prescription Drug Plan (PDP) EGWP Secure Form
Please complete this form if you wish to opt out of the FSBP-Express Scripts Medicare®️ Prescription Drug Plan (PDP)
