FSBP – Express Scripts Medicare Prescription Drug Plan (PDP)
A plan for FSBP Medicare-eligible members aged 65 and above
FSBP – Express Scripts Medicare Prescription Drug Plan (PDP)
The Foreign Service Benefit Plan (FSBP) offers an FSBP – Express Scripts Medicare Prescription Drug Plan (PDP) designed for FSBP Medicare-eligible members, age 65 and above, and eligible for Medicare Parts A and/or B.
The PDP offers significant prescription drug savings compared to the High Option prescription benefits while making no change to your other benefits under FSBP. Your prescription drug benefits will continue to be administered by Express Scripts Inc. (ESI), and the PDP formulary includes all drugs on the High Option formulary. See below for a comparison of member out-of-pocket costs under each option.
| 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: $12 copay Retail/Mail 90-Day Supply: $20 copay | Retail 30-Day Supply: $2 copay Retail/Mail 90-Day Supply: $4 copay |
| Preferred Brand Drug | Retail 30-Day Supply: 35% coinsurance ($150 maximum) Retail/Mail 90-Day Supply: 35% coinsurance ($300 maximum) | Retail 30-Day Supply: $40 copay Retail/Mail 90-Day Supply: $60 copay |
Non-Preferred and Non-Formulary Brand Drug | Retail 30-Day Supply: 45% coinsurance ($300 maximum) Retail/Mail 90-Day Supply: 45% coinsurance ($400 maximum) | Retail 30-Day Supply: $75 copay Retail/Mail 90-Day Supply: $150 copay |
| Specialty Drug | Retail 30-Day 90-Day Supply: 35% coinsurance up to a maximum of $240 | Retail/Mail 30-Day and 90-Day Supply: 25% coinsurance up to a $150 maximum |
Beginning in 2027, newly eligible members will be automatically enrolled in the FSBP-Express Scripts Medicare Prescription Drug Plan (PDP). Members will receive written notification before their enrollment takes effect and will have the opportunity to opt out.
All eligible members may opt in or opt out of the PDP at any time, without waiting for Open Season or experiencing a qualifying life event. Changes typically take effect on the first day of the following calendar month and cannot be applied retroactively.
To opt in or opt out of the PDP, scroll to the bottom of this page and complete the appropriate form. You will receive an email confirming your enrollment change.
For assistance, call 202-833-4910 to speak with a member of our Enrollment and Eligibility Services team.
- How do I Opt In or Opt out of the PDP
To make changes to your PDP enrollment, follow these steps:
Scroll to the bottom of this page to locate the PDP enrollment form.
Select your enrollment request/change to opt in or opt out (disenroll) of the PDP.
Submit your form. You will receive a confirmation email regarding your enrollment change.
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, Monday to Friday, 7:00am – 7:00pm 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. 2025 income determines 2027 D-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.
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Forms & Resources
- FSBP – Express Scripts Medicare Prescription Drug Plan (PDP) Secure Form
Please complete this form if you wish to opt in or opt out of the FSBP-Express Scripts Medicare Prescription Drug Plan (PDP). Please note that any changes typically are effective at the start of the next calendar month. Changes cannot be made retroactively.