2024 TRS-Care Standard FAQs | Revised 8/5/24 | Page 1 of 16
Teacher Retirement System of Texas
Frequently Asked Questions:
TRS-Care Standard for the 2024 Plan Year
Revised Aug. 5, 2024
2024 TRS-Care Standard FAQs | Revised 8/5/24 | Page 2 of 16
Contents (Click on a question to jump to that question or use the bookmarks in the PDF viewer to navigate.)
General Questions ..................................................................................................................... 4
What is the difference between TRS-Care Standard and TRS-Care Medicare Advantage? ............................... 4
What are my TRS-Care premiums? ..................................................................................................................... 4
Who should I contact if I have questions? .......................................................................................................... 4
Eligibility and Enrollment Questions: TRS Health ....................................................................... 5
Which plan am I eligible for? .............................................................................................................................. 5
When can I enroll in TRS-Care?........................................................................................................................... 5
How do I send my premium payments? ............................................................................................................. 5
What is the difference between annual deductible and annual maximum out-of-pocket? .............................. 5
What does and doesn’t count toward my deductible? ...................................................................................... 6
What is coinsurance? .......................................................................................................................................... 6
If I leave TRS-Care, can I come back? .................................................................................................................. 6
How do I add a dependent to my existing TRS-Care coverage? ......................................................................... 6
How do I remove a dependent from my TRS-Care coverage? ........................................................................... 6
How do I completely terminate my TRS-Care coverage? ................................................................................... 7
If I terminate TRS-Care coverage, when will my annuity change? ..................................................................... 7
Who should I call about my Consolidated Omnibus Budget Reconciliation Act (COBRA) options? .................. 7
Do I need to do anything to stay enrolled in TRS-Care Standard? ..................................................................... 7
Medical Questions: Blue Cross and Blue Shield of Texas (BCBSTX)............................................. 8
ID Cards ............................................................................................................................................................... 8
Will I get a new ID card for the 2024 plan year? ............................................................................................ 8
How can I get another ID Card? ...................................................................................................................... 8
Provider Finder and In-Network Providers ......................................................................................................... 8
Will I benefit from using an in-network provider instead of an out-of-network provider? ........................... 8
How can I find an in-network provider or hospital? ....................................................................................... 8
What is the name of my health plan’s network? ............................................................................................ 8
Can my current doctor become an in-network provider? .............................................................................. 8
If my doctor is listed in Provider Finder, does that mean they are in network? ............................................ 8
Benefits ............................................................................................................................................................... 9
What are my TRS-Care Standard plan benefits?............................................................................................. 9
When I retire, I’ll switch from my current insurance to TRS-Care Standard. Will I have to meet a new
deductible when I change? ............................................................................................................................. 9
How can I find out what services, procedures and equipment TRS-Care Standard covers? ......................... 9
Does the plan qualify as a high-deductible plan that’s eligible for a Health Savings Account (HSA)? ........... 9
What is the difference between preventive and diagnostic services at a doctor’s visit? .............................. 9
Are treatments for pre-existing conditions covered as preventive? .............................................................. 9
Are colonoscopies preventive? ....................................................................................................................... 9
Does BCBSTX offer transportation to and from medical appointments? .................................................... 10
How should I determine where to go for care? ............................................................................................ 10
2024 TRS-Care Standard FAQs | Revised 8/5/24 | Page 3 of 16
Primary Care Provider (PCP) and Referrals ....................................................................................................... 10
Am I required to have a PCP? ....................................................................................................................... 10
How can I find a PCP?.................................................................................................................................... 10
Do I need a referral or prior authorization to see a specialist? .................................................................... 10
BCBSTX App ....................................................................................................................................................... 10
What is Blue Access for Members (BAM)? ................................................................................................... 10
Out-of-State Coverage ...................................................................................................................................... 11
Do I have coverage outside of Texas?........................................................................................................... 11
What happens if my dependent lives out of state?...................................................................................... 11
TRS Virtual Health (Telemedicine) .................................................................................................................... 11
Do I have a virtual health (telemedicine) option? ........................................................................................ 11
What are my virtual mental health benefits through TRS? .......................................................................... 11
Can a Teladoc or RediMD provider write me a prescription from anywhere? ............................................ 11
The Fitness Program and Blue Points
SM
............................................................................................................ 11
What is the Fitness Program? ....................................................................................................................... 11
How much does the Fitness Program cost? .................................................................................................. 12
What are Blue Points and how do they work? ............................................................................................. 12
Are Blue Points available for dependents? ................................................................................................... 12
Vision and Dental Benefits ................................................................................................................................ 12
Does TRS-Care Standard offer vision or dental benefits?............................................................................. 12
Claims and Billing .............................................................................................................................................. 13
I paid out of pocket for a doctor’s appointment. How do I submit that information? ................................ 13
Are treatments for pre-existing conditions covered as preventive? ............................................................ 13
What is the allowed amount? ....................................................................................................................... 13
Can an out-of-network provider balance bill me? ........................................................................................ 13
Prescription Drug Questions: Express Scripts (ESI) ................................................................... 14
Who is the pharmacy benefit manager (PBM) for TRS-Care Standard? .......................................................... 14
What benefits do I have under the TRS-Care Standard prescription drug plan? ............................................. 14
Is my local pharmacy in the network? .............................................................................................................. 14
I lost my Rx ID card. How can I order a new one? ............................................................................................ 14
How can I find a Retail-Maintenance Network Pharmacy? .............................................................................. 14
How can I save money on prescription drugs? ................................................................................................. 15
Where can I access the drug formulary and find out my medication cost? ..................................................... 15
Are there medications Express Scripts does not cover? .................................................................................. 15
Do I need a prior authorization to get pain medication? ................................................................................. 15
How much will I pay for insulin? ....................................................................................................................... 15
Which insulins does TRS-Care Standard cover? ............................................................................................... 16
What specialty pharmacy can I use? ................................................................................................................ 16
What is SaveOnSP? ........................................................................................................................................... 16
What are non-preferred drugs?........................................................................................................................ 16
What is my copay/coinsurance responsibility? ................................................................................................ 16
2024 TRS-Care Standard FAQs | Revised 8/5/24 | Page 4 of 16
General Questions
What is the difference between TRS-Care Standard and TRS-Care Medicare
Advantage?
TRS-Care Standard is a high-deductible health plan that TRS offers to retirees and their family members under
age 65 years of age and not yet eligible for Medicare. TRS-Care Standard includes medical and prescription
drug benefits.
TRS-Care Medicare Advantage is for retirees and their eligible family members who are eligible for and
enrolled in traditional Medicare Part A and Part B or Part B only. TRS-Care Medicare Advantage (MA) is the
medical plan and TRS-Care Medicare Rx is the prescription drug plan.
What are my TRS-Care premiums?
The TRS retiree’s Medicare eligibility determines their premium, regardless of their dependents’ Medicare
status. For example:
• If you’re the TRS retiree and not eligible for Medicare and you cover your spouse who is eligible for
Medicare, you pay $689 per month for both of you because you, as the retiree, are not yet eligible for
Medicare.
• If you’re the TRS retiree and eligible for Medicare and you cover your spouse who is not eligible for
Medicare, you pay $529 per month for both of you because you, as the retiree, are eligible for
Medicare.
Visit 2024 TRS-Care Plan Highlights to see your monthly premiums.
Who should I contact if I have questions?
For enrollment and eligibility questions, call TRS Health at 1-888-237-6762, 7 a.m.–6 p.m. CT, Mon–Fri or visit
TRS-Care Eligibility and Enrollment.
For medical benefits questions, call BlueCross BlueShield of Texas at 1-866-355-5999, 24 hours a day, seven
days a week or visit TRS-Care Standard by BCBSTX.
For prescription drug questions, call Express Scripts at 1-855-778-1459, TTY 711, 24 hours a day, seven days a
week or visit TRS-Care Standard by Express Scripts.
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Eligibility and Enrollment Questions: TRS Health
Which plan am I eligible for?
The retiree’s Medicare status determines TRS-Care plan eligibility:
• TRS-Care Standard is for retirees without Medicare (people younger than 65).
• TRS-Care Medicare Advantage is for retirees eligible for Medicare (people aged 65 or older).
Visit TRS-Care Eligibility and Enrollment for more information.
When can I enroll in TRS-Care?
TRS-Care enrollment is available only during specific windows of opportunity.
You have an initial enrollment opportunity to join TRS-Care when you retire. If you decide not to enroll in TRS-
Care when you retire, you have two other potential chances to enroll:
• If you have a special enrollment event. Special enrollment events may arise from an involuntary loss
of coverage or when you gain a new dependent through marriage, birth, adoption, or placement for
adoption.
• When you turn 65.
Visit TRS-Care Eligibility and Enrollment and 2024 TRS-Care Standard Guide for Participants without Medicare
for more information.
How do I send my premium payments?
You pay your TRS-Care premium to TRS. In most cases, TRS will withhold your TRS-Care premium from your
monthly annuity payment.
What is the difference between annual deductible and annual maximum out-of-
pocket?
• A deductible is the cost you pay out of pocket to your healthcare provider before the TRS-Care plan
starts to cover certain expenses.
• A maximum out-of-pocket, or MOOP, is the amount you must spend on eligible health care expenses
through copays, coinsurance and deductibles before the plan starts to cover all eligible expenses at
100%.
TRS-Care Standard participants have a $1,600 deductible and a $5,650 maximum out-of-pocket per person (in-
network). Deductibles and maximum-out-of-pocket amounts reset every Jan. 1.
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What does and doesn’t count toward my deductible?
With some exceptions, you pay the full cost of your medical and prescription costs until you or your family
reach the deductible. This plan covers certain preventive services before you meet your deductible and
without cost sharing. See a list of covered preventive services at Preventive Health Services (healthcare.gov).
What is coinsurance?
Coinsurance is a percentage you pay for certain services such as outpatient surgery. For example, on TRS-Care
Standard, outpatient surgery is covered at 20% coinsurance (in-network) after you meet your annual
deductible. This means that once you meet your deductible, the plan pays 80% of the allowed amount and you
pay the remaining 20% coinsurance.
If I leave TRS-Care, can I come back?
If a retiree or surviving dependent (including a surviving spouse) leaves TRS-Care, they have limited
opportunities to reenter the program:
• When they have a special enrollment event. Special enrollment events may arise from an involuntary
loss of coverage or when you gain a new dependent through marriage, birth, adoption, or placement
for adoption. See the special enrollment events section at TRS-Care Eligibility and Enrollment for
details.
• When they turn 65.
For questions on special enrollment events, call TRS Health at 1-888-237-6762, Mon–Fri, 7 a.m.–6 p.m. CT.
How do I add a dependent to my existing TRS-Care coverage?
• You may add a new dependent only during your Initial Enrollment Period or a Special Enrollment
Event.
• Call TRS Health at 1-888-237-6762 to get an enrollment application and complete information about
adding new dependents (for example, marriage, adoption, guardianship, divorce).
• The coverage starts the first of the month after TRS gets your application.
• If a dependent who previously waived TRS-Care coverage loses other health coverage through no fault
of their own, the dependent may qualify for a special enrollment event. They may enroll in TRS-Care
within 31 days from the date of they lose their other health coverage. Call TRS Health at 1-888-237-
6762 to get a Special Enrollment Event application.
• A surviving spouse cannot add a new spouse.
How do I remove a dependent from my TRS-Care coverage?
You can remove dependents from your coverage at any time. Call TRS Health at 1-888-237-6762 to ask for the
form to remove dependents. You must complete, sign and return the form to TRS to remove your dependents.
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You must specify which dependent(s) you want to remove from coverage. If you don’t sign the request, TRS
cannot process it. The termination starts on the first of the month after TRS gets your request.
Once you remove a dependent from your coverage, you may not get a chance to add them back later.
How do I completely terminate my TRS-Care coverage?
Call TRS Health at 1-888-237-6762 for a coverage termination form. You must sign and notarize the form. Once
TRS cancels your TRS-Care coverage, you will have a 31-day grace period from the effective date of
termination to contact TRS for a reinstatement form or to get instructions to submit a written reinstatement
request. Reinstatement of coverage will start the first day of the following month assuming TRS gets your
documentation in the 31-day grace period. After this 31-day grace period, you can’t reenroll in TRS-Care
unless you have a special enrollment event, qualifying life event or reach age 65.
Cancellations take effect the first day of the month after TRS gets your notarized coverage termination form.
If you’re the surviving spouse of a TRS retiree and enrolled in TRS-Care, you can send a notarized coverage
termination form or you can send TRS a written request to cancel your TRS-Care coverage. The request must
have your signature. TRS accepts scanned copies.
If I terminate TRS-Care coverage, when will my annuity change?
You’ll see the change at the end of the month you terminate your coverage. For example, if you terminate
coverage starting Jan. 1, your last day of coverage would be Dec. 31 and will be paid from your Dec. 31 annuity
check. Your Jan. 31 annuity check will reflect the change that became effective Jan. 1.
Who should I call about my Consolidated Omnibus Budget Reconciliation Act
(COBRA) options?
Blue Cross and Blue Shield of Texas (BCBSTX) administers COBRA. Call TRS Health at 1-888-237-6762 to ask if
you’re eligible for COBRA and request an application. Once enrolled in COBRA, talk to a Personal Health Guide
at 1-866-355-5999 for help.
Do I need to do anything to stay enrolled in TRS-Care Standard?
If you’re enrolled in TRS-Care Standard, you don’t need to do anything until three months before you or your
covered dependent turns 65. You’ll stay enrolled until you decide to cancel your coverage or until you turn 65
and become eligible for TRS-Care Medicare Advantage. For more information about how to enroll in Medicare,
go to Are you turning 65 soon?
2024 TRS-Care Standard FAQs | Revised 8/5/24 | Page 8 of 16
Medical Questions: Blue Cross and Blue Shield of Texas (BCBSTX)
ID Cards
Will I get a new ID card for the 2024 plan year?
TRS-Care Standard participants will get a new ID card for the 2024 plan year.
How can I get another ID Card?
Use the BCBSTX App, go to TRS-Care Standard by BCBSTX and log in to Blue Access for Members
SM
(BAM
SM
), or
call a Personal Health Guide at 1-866-355-5999 to ask for a new ID card.
Provider Finder and In-Network Providers
Will I benefit from using an in-network provider instead of an out-of-network provider?
An in-network doctor or health care provider is one who contracts with BSBSTX to provide services to TRS-
Care participants. You pay your copay or coinsurance according to your TRS-Care Standard benefits. If you
choose out-of-network providers, you may have higher out-of-pocket costs and benefits will be paid at the
out-of-network benefits level. Your provider may require you to submit claims for the services provided,
rather than bill BCBSTX directly. You may also be subject to balance billing from out-of-network providers.
How can I find an in-network provider or hospital?
Use Provider Finder to see providers and hospitals in the nationwide network. Go to TRS-Care Standard by
BCBSTX and click on Doctors and Hospitals to search. Or log in to BAM for personalized Provider Finder results
or call a Personal Health Guide at 1-866-355-5999.
What is the name of my health plan’s network?
Your health plan’s network is Blue Choice PPO. To check if your provider is in-network, ask if they’re a PPO
contracting provider with BCBSTX’s Blue Choice PPO instead of asking if they accept BCBSTX.
Can my current doctor become an in-network provider?
Nominate a provider for the BCBSTX network at TRS-Care Standard by BCBSTX. Click on Doctors and Hospitals
and then Nominate a Provider. Check Provider Finder or call a Personal Health Guide at 1-866-355-5999 after
30 to 60 days to check the provider’s status.
If my doctor is listed in Provider Finder, does that mean they are in network?
Yes. Your doctor is in-network if they are listed in Provider Finder.
2024 TRS-Care Standard FAQs | Revised 8/5/24 | Page 9 of 16
Benefits
What are my TRS-Care Standard plan benefits?
Find more information about benefits at TRS-Care Standard by BCBSTX.
When I retire, I’ll switch from my current insurance to TRS-Care Standard. Will I have to meet a new deductible
when I change?
Yes. You will have to meet a new deductible under TRS-Care Standard.
How can I find out what services, procedures and equipment TRS-Care Standard covers?
Visit www.bcbstx.com/trscarestandard/coverage. Check out the Summary of Benefits & Coverage, and the
Benefits Booklet. You can also call a Personal Health Guide at 1-866-355-5999.
Does the plan qualify as a high-deductible plan that’s eligible for a Health Savings Account (HSA)?
Yes. The TRS-Care Standard plan qualifies as a high-deductible plan and is eligible for an HSA that you can set
up outside of TRS.
What is the difference between preventive and diagnostic services at a doctor’s visit?
The purpose of a preventive care service is to prevent certain illnesses and diseases. The purpose of a
diagnostic service is to find the nature and cause of an illness or other medical concern, along with the method
of treatment.
Are treatments for pre-existing conditions covered as preventive?
No. If you’re getting care for a known medical condition, that care is diagnostic.
Are colonoscopies preventive?
TRS-Care Standard covers screening colonoscopies as preventive service with a $0 copay. If you have a history
of colon cancer or had polyps removed in a past colonoscopy, all future colonoscopies are diagnostic and
covered as an outpatient surgery. Call a Personal Health Guide at 1-866-355-5999 to find out if your
colonoscopy is routine or diagnostic.
Do I need a doctor’s order to schedule my annual mammogram?
No. Your annual screening mammogram does not require a written order. As with colonoscopy, screening
mammograms are covered as a preventive service with $0 copay. But if a previous screening mammogram
resulted in additional diagnostic studies, future mammograms may have out-of-pocket cost.
Can I get a list of preventive care that is covered?
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Call a Personal Health Guide at 1-866-355-5999. They can provide information on all preventive services
available to you.
Is there a difference between a wellness visit and annual checkup?
There can be a difference in patient responsibility for your annual checkups, depending on how your doctor
bills the service. Call a Personal Health Guide at 1-866-355-5999 if you have questions on billing. PHGs can
reach out to your doctor if you feel your bill has errors.
Do I have to use a specific lab for lab work?
We recommend calling a Personal Health Guide at 1-866-355-5999 before getting labs so you can verify that
the lab you want to use is in-network.
Does BCBSTX offer transportation to and from medical appointments?
No. BCBSTX does not provide transportation services for plan participants.
How should I determine where to go for care?
Call the 24/7 Nurseline at 1-833-968-1770. A registered nurse can help you decide if you should go to an
emergency room (ER), urgent care center or make an appointment with your doctor.
Primary Care Provider (PCP) and Referrals
Am I required to have a PCP?
No. TRS-Care Standard does not require a PCP. But we recommend having a PCP to help manage your health
care needs.
How can I find a PCP?
Use the BCBSTX Provider Finder at TRS-Care Standard by BCBSTX. Click on Doctors and Hospitals. You can also
call a Personal Health Guide at 1-866-355-5999 for help.
Do I need a referral or prior authorization to see a specialist?
You don’t need a referrals and prior authorizations to see a specialist. But be sure to use in-network providers
to ensure the highest level of benefits.
BCBSTX App
What is Blue Access for Members (BAM)?
BAM is a secure website for TRS-Care Standard participants. Use it to view claims, download an explanation of
benefits (EOB) statement, look for providers, chat with Personal Health Guides, and more. To get the BCBSTX
App, text BCBSTXAPP to 33633 or search BCBSTX in the Apple App Store or Google Play Store.
2024 TRS-Care Standard FAQs | Revised 8/5/24 | Page 11 of 16
Out-of-State Coverage
Do I have coverage outside of Texas?
Yes. You have nationwide coverage, so TRS-Care Standard covers you if you move or travel out of state. You
also have emergency care when you travel internationally.
What happens if my dependent lives out of state?
If your covered dependents are out of state for any length of time, they can continue to use BCBSTX’s
extensive nationwide network of providers. Call a Personal Health Guide at 1-866-355-5999 for help finding an
in-network provider.
TRS Virtual Health (Telemedicine)
Do I have a virtual health (telemedicine) option?
Yes. You have low cost virtual care options through Teladoc® and RediMD™ for medical and mental health.*
You can see a doctor 24/7 or make an appointment with a mental health specialist, whether you’re traveling,
taking a lunch break or want care from the comfort of home. Download the Teladoc and RediMD App from the
Apple App Store or Google Play Store. Teladoc providers will send your prescription to your preferred
pharmacy in any state.
RediMD charges a $30 copay per visit. Teladoc charges a $42 copay per visit. Both copays apply to your
deductible. When you meet your deductible, the plan pays 80% and you pay 20%.
*RediMD does not provide mental health care.
What are my virtual mental health benefits through TRS?
• Psychiatrist (initial consultation) = $185 before deductible/$37 after deductible
• Psychiatrist (ongoing consultations) = $95 before deductible/$19 after deductible
• Psychologist or licensed clinical social worker consultations = $85 before deductible/$17 after
deductible
Can a Teladoc or RediMD provider write me a prescription from anywhere?
Teladoc and RediMD have providers throughout the United States. The provider you see can send a
prescription to a pharmacy near you, if necessary, but they can’t fill ongoing prescriptions. The provider may
be able to fill a prescription if they feel it's medically necessary until you can see your physician in person.
They also can’t prescribe controlled substances.
The Fitness Program and Blue Points
SM
What is the Fitness Program?
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Discounted gym and fitness memberships are available through the Fitness Program. With affordable, no-
contract memberships, you can go to any participating gym facility in the program’s nationwide network. You
can exercise even when you’re traveling. Plus, save on wellbeing services like acupuncture, massage and
personal training. You must be age 18 or older to buy a membership.
How much does the Fitness Program cost?
The Fitness Program has an initiation fee of $19. Monthly fees range from $19 to $129, depending on the size
of the gym network you choose. It’s easy to sign up.
1. Log in at TRS-Care Standard by BCBSTX.
2. Click on Wellness and then Fitness Program. On this page, you can enroll, search for nearby fitness
locations and learn more about the program.
3. Click Enroll Now. Then search and select the fitness location that’s best for you. Remember, you can
visit any participating fitness location in your plan after you sign up.
4. Verify your personal information and method of payment. Print or download your Fitness Program ID
card. You may also ask to get your ID card in the mail.
5. Visit a fitness location today!
What are Blue Points and how do they work?
Blue Points is a special program that lets you earn points to redeem for things like books, music, sporting
goods, electronics, entertainment—anything that motivates you to keep making healthy choices. You earn
Blue Points when you:
• take a health assessment
• link a fitness device
• exercise
• complete an online, self-directed course
Are Blue Points available for dependents?
Blue Points are available for dependents eighteen and older with a BAM account.
Vision and Dental Benefits
Does TRS-Care Standard offer vision or dental benefits?
• No. TRS-Care Standard does not offer routine vision and dental benefits.
• TRS-Care Standard covers routine eye exams if you have diabetes. Exams are subject to the deductible
and coinsurance.
• TRS-Care Standard covers glasses within 12 months after intraocular surgery or accidental injury. The
plan covers 80% of your first pair of glasses, frames, lenses or contact lenses, after you meet your
deductible, up to the allowed amount.
• TRS-Care Standard may cover dental services if they are a medical service.
• Call a Personal Health Guide at 1-866-355-5999 for more benefit questions.
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Claims and Billing
I paid out of pocket for a doctor’s appointment. How do I submit that information?
Call a Personal Health Guide at 1-866-355-5999 for a medical claim form. The medical claim form is also at
TRS-Care Standard by BCBSTX under Tools and Resources.
Are treatments for pre-existing conditions covered as preventive?
If you’re getting care for a known medical condition, it’s considered diagnostic.
What is the allowed amount?
In-network providers have negotiated rates, or allowed amounts, in their contracts. The allowed amount is the
maximum amount TRS-Care Standard will pay for a covered service.
The allowed amount is lower for out-of-network providers, so always see in-network providers to avoid
balance billing. In areas where there is no network, your plan covers medical expenses based on reasonable
and customary charges, determined by claims from the same types of providers in a geographic region.
Can an out-of-network provider balance bill me?
Balance billing is when a medical provider or facility bills patients the difference between provider charges and
insurance company allowed amounts. In-network providers may not balance bill for covered services. To
prevent balance billing, be sure to use in-network doctors and providers.
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Prescription Drug Questions: Express Scripts (ESI)
Who is the pharmacy benefit manager (PBM) for TRS-Care Standard?
Express Scripts is the pharmacy benefit manager for the TRS-Care Standard prescription drug plan.
If you have questions or need an ID card, call Express Scripts TRS-Care Standard Customer Support at 1-855-
778-1459, 24 hours a day, seven days a week or visit TRS-Care Standard by Express Scripts for more
information.
What benefits do I have under the TRS-Care Standard prescription drug plan?
Participants enjoy:
• No convenience fees on maintenance medications with less than a 90-day supply
• Lower copays
• No cost difference between brand-name and generic drugs
Find more information at TRS-Care Standard by Express Scripts.
Is my local pharmacy in the network?
You may use any pharmacy in the Express Scripts retail network. You can fill long-term supplies (up to a 90-day
supply) of maintenance medications at Retail-Maintenance pharmacies.
I lost my Rx ID card. How can I order a new one?
If you need a replacement ID card, ask for one from Express Scripts at 1-855-778-1459. They will mail it to you.
How can I find a Retail-Maintenance Network Pharmacy?
Call Express Scripts at 1-855-778-1459 to find a Retail-Maintenance Network Pharmacy near you—or visit us
online to find a list of network pharmacies:
1. Go to TRS-Care Standard by Express Scripts.
2. Click on Explore your Plan.
3. Click on Find a Pharmacy.
4. Enter your zip code and click Search.
5. Review the list of pharmacies in your network.
6. Click on your preferred in-network pharmacies for details.
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How can I save money on prescription drugs?
You can get certain preventive generic drugs at no added cost through TRS-Care Standard by Express Scripts.
We encourage you to ask your doctor about switching to a generic. Check our prescription drug list to see if
your plan covers your medication at no added cost:
1. Go to TRS-Care Standard by Express Scripts.
2. Click on Explore your Plan.
3. Click on the PDF links to download copies:
• Formulary Guide
• TRS Preferred Drug List
• TRS Preventive Drug List
If you get your medications from the Express Scripts Mail Order Pharmacy, you can split the payments for a
90-day supply into three payments over three months. Call Express Scripts at 1-855-778-1459 for more
information.
Where can I access the drug formulary and find out my medication cost?
View your drug formulary and search your medication cost at TRS-Care Standard by Express Scripts. Use the
explore your plan and price medication tool "Check Drug Costs." You can also call Express Scripts at 1-855-778-
1459 to confirm your medication cost.
Are there medications Express Scripts does not cover?
Yes. Medications not listed on the formulary are "non-formulary drugs." If you learn that TRS-Care Medicare
Rx by Express Scripts does not cover your drug, Express Scripts can help you find a generic or lower cost
equivalent.
Do I need a prior authorization to get pain medication?
Yes. In response to the growing opioid epidemic, Express Scripts has a strict quantity limit on opioids. Your
doctor may need to submit a quantity limit prior authorization. Call Express Scripts at 1-855-778-1459 to ask if
your pain medication requires a prior authorization.
How much will I pay for insulin?
The 87th Texas Legislature passed State Bill 827, which lowers the cost of insulin for people on TRS-Care
Standard. This change started Jan. 1, 2022.
TRS-Care Standard caps formulary insulins at $25 for a 31-day supply and $75 for a 60- to 90-day supply. You
don’t have to meet your deductible to get this price. You pay only a copay for covered insulin, which does not
apply toward your deductible. Your copay does apply towards your maximum out-of-pocket costs.
2024 TRS-Care Standard FAQs | Revised 8/5/24 | Page 16 of 16
Which insulins does TRS-Care Standard cover?
For a list of the covered formulary insulins, visit TRS-Care Standard by Express Scripts to view the Express
Scripts® Formulary.
For diabetic supplies, you can get preferred test strips, lancets, alcohol prep pads, and needles at $0 for a 90-
day supply at Retail-Maintenance pharmacies or Express Scripts Mail Order Pharmacy.
What specialty pharmacy can I use?
Accredo, an Express Scripts specialty pharmacy, is your exclusive specialty pharmacy. For more informaon, call
Accredo at 1-800-596-7701.
What is SaveOnSP?
Starting Jan. 1, 2024, Express Scripts will offer SaveOnSP, a copay assistance program. The program helps TRS-
Care Standard participants save money while eliminating member cost share for specialty medications.
SaveOnSP helps TRS-Care Standard participants use manufacturer copay assistance to help them get lower
drug prices. Formulary and prior authorization requirements still apply.
The SaveOnSP Copay Assistance Program lets you get select specialty medication at no added cost. That
means $0 out-of-pocket (OOP) for any drug on your plan’s exclusive SaveOnSP Specialty Drug list when you fill
your prescription with Accredo Specialty Pharmacy. Call SaveOnSP at 1-800-683-1074 to learn more.
What are non-preferred drugs?
Non-preferred drugs have an alternave brand (or generic) with less cost to you. These alternave drugs are in
the same class and approved by FDA to work the same as the non-preferred drugs.
What is my copay/coinsurance responsibility?
1. Go to TRS-Care Standard by Express Scripts.
2. Click on Explore your Plan.
3. Click on Price a Medication.
4. Enter your medication name and zip code.
5. Click on Get Prices.
6. Review your medication cost.
You can also call Express Scripts at 1-855-778-1459 to get the price of a medication.
