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Prescription Drug Coverage

When you enroll in a Benefits 2000 medical option, you automatically receive Prescription Drug Coverage from Medco.

• Retail Program (for short-term medications)
• Mail-Order Program (for long-term medications)

Retail Program

If you purchase a covered prescription from a pharmacy that participates in the Medco network for a 30-day supply, you’ll pay:

• 15% coinsurance for generic drugs—$50 maximum;
• 15% coinsurance for brand-name formulary drugs—$50 maximum; and
• 30% coinsurance for brand-name drugs not on Medco's formulary—$50 maximum.

Note: If you or your doctor requests a brand-name drug when a generic is available, you'll pay the generic coinsurance amount plus the difference between the cost of the generic and the brand-name drug for prescriptions filled at a retail pharmacy.

Notes

1. Any prescriptions written above the manufacturers daily dose limit will be reviewed by the retail pharmacist before dispensing. This safety measure is already performed through the mail order service and ensures the appropriate quantity of a medication is dispensed for specific disease indications, according to clinical practice guidelines.
2. If you purchase a prescription drug from a pharmacy that does not participate in the Medco Retail Program (a non-network pharmacy), you pay the full price, then submit a claim form to Medco. For both generic and brand-name prescriptions, you'll be reimbursed 75% of the cost, minus the normal coinsurance.
3. After the initial prescription plus two refills are purchased at the retail pharmacy, additional refills for the same prescription must be filled at the mail order pharmacy in order to receive benefits under the plan.

Mail-Order Program

If you purchase a covered prescription through the Medco Mail-Order Program for a 90-day supply, you’ll pay:

• 15% coinsurance for generic drugs—$100 maximum;
• 15% coinsurance for brand-name formulary drugs—$100 maximum; and
• 30% coinsurance for brand-name drugs not on Medco's formulary—$100 maximum.

Note: If you or your doctor requests a brand-name drug when a generic drug is available, you’ll pay the generic coinsurance amount plus the difference between the cost of the generic and the brand-name drug for prescriptions filled through the mail order service pharmacy.

Participants who fill a maintenance drug at a retail pharmacy will be required to fill it through the mail order service after the second refill or pay 100% of the cost of the drug.

Please note: Certain prescriptions are only available through the Mail-Order Program. For example, birth control pills and Viagra are only covered through the Mail-Order Program. Viagra is covered at 10 pills per month.

The formulary is a list of preferred prescription drugs. Medco has negotiated a preferred rate for certain drugs that are part of a formulary. You have the opportunity to save money out of pocket if you choose these prescription drugs. You should share the formulary with your doctors and pharmacist to ensure you're getting the most cost-effective prescriptions.

For an idea of prescription costs and more information, you can link directly to Medco.

For a more detailed description of your benefits, see Prescription Drug Coverage under the Medical Benefits Program section of the Benefits 2000 Non-Represented summary plan description.