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| Copay | |||
|---|---|---|---|
| Up to 30-day Supply | 31-60 day Supply | 61-90 day Supply | |
| Tier 1 Generics | $12 | $24 | $36 |
| Tier 2 Preferred Brand | $40 | $80 | $120 |
| Tier 3 Non-Preferred Brand |
$64 | $128 | $192 |
| Brand name drug with a generic equivalent | Generic copay + the difference between the Plan's cost of the brand name drug and the Plan's cost of the generic drug not to exceed $100 per a 30-day supply of the brand medication. | ||
| Specialty Medications | 25% coinsurance up to $100 for each 30-day supply | ||
| Diabetic Testing Supplies Copay* | |||
|---|---|---|---|
| Up to 30-day Supply | 31-60 day Supply | 61-90 day Supply | |
| Preferred Brand | $10 | $20 | $30 |
| Non-preferred Brand | $25 | $50 | $75 |
*Insulin dependent members will receive 153 test strips and non-insulin dependent members will receive 51 test strips per 30-day supply. Additional test strips are covered under your medical benefit.
Prescription drug copayments are limited to $2,500 per person per benefit period. After the $2,500 maximum is reached, the State Health Plan pays 100 percent of allowed prescription drug charges per benefit period. All copays including specialty and any cost difference paid for brand drugs when a generic equivalent is available are applied to the $2500 maximum.
The State Health Plan provides a preferred drug list to promote clinically appropriate utilization of pharmaceuticals in a cost-effective manner. The list is developed by the Plan's Pharmacy and Therapeutics Committee, is based on safety, effectiveness and clinical outcomes and is updated quarterly.
- April 2012 Preferred Drug List, click here.
- January 2012 Preferred Drug List, click here.
- Preferred Drug List FAQs & Tips
To comply with pharmacy "best practice" standards and regulatory requirements the State Health Plan follows criteria to determine when a prescription can be refilled. For information about the State Health Plan's refill guidelines, click here.
Some drugs may require prior approval, step therapy, or be subject to quantity limits (see Prior Authorization Page). It is very important to make sure that prior approval is received before going to the Pharmacy.
Specialty medications are used for the treatment of complex diseases, require special dosing or administration, require special handling and are typically prescribed by a specialist provider. In order to obtain non-acute, specialty medications covered under the pharmacy benefit, excluding cancer medications, members must use the Plan's contracted specialty vendor. Click here to view specialty medications.
Mail order is available for members requiring long-term prescriptions. Enjoy the convenience of having your long-term medications delivered to your home or office by using the Medco Pharmacy, the Plan's mail order pharmacy.
My Rx Choices lets you review and identify potential cost-saving alternatives for your prescriptions and is available at www.medco.com. Savings can come from generics, lower-cost brand name alternatives, over-the-counter medications, or using Medco Pharmacy.
For questions regarding your prescription benefit, please call Medco Customer Service at 800-336-5933, or visit Medco's website.
