Important Information about the
Empire Plan Prescription Drug Program
Effective January 1, 2008, the New York State Health Insurance Program’s Empire Plan Prescription Drug Program will be administered by UnitedHealthcare. UnitedHealthcare will use the administrative and mail distribution services of Medco Health Solutions, Inc. (Medco), a leading pharmacy benefit manager with the nation’s largest mail order pharmacy operations.
The New York State Health Insurance Program’s Empire Plan Prescription Drug Program and UnitedHealthcare want you and your family to get the most from your benefits. To keep you up to date, we’d like to make sure you have the following information.
The Empire Plan Prescription Drug Program uses a three level copayment benefit structure:
· Generics – If you use a generic version of a brand name drug – a safe, effective drug approved by the U.S. Food and Drug Administration (FDA) as equivalent to the brand version – you pay the lowest copayment.
· Preferred Brands – If you use a preferred brand name drug on the enclosed 2008 Empire Plan Preferred Drug List, you pay a higher copayment.
· Non-Preferred Brands – If you use a non-preferred brand name drug that is not included on the 2008 Empire Plan Preferred Drug List, you pay the highest copayment.
Pharmacy records show that the medication(s) you may be taking will be covered under your prescription benefit and will result in a non-preferred copayment being charged beginning January 1, 2008. For your reference, the following table lists the drug(s) you may be taking that will become non-preferred brand name drugs on January 1, 2008 and provides alternatives included on the 2008 Empire Plan Preferred Drug List. You may want to discuss with your doctor one of the alternative medication(s) included on the 2008 Empire Plan Preferred Drug List that will result in you paying a lower copayment.
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2008 Preferred Drug List Alternatives |
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Non-Preferred Brand Name Drug |
Generic Drug Alternatives |
Preferred Brand Name Drug Alternatives |
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The following copayments for drugs purchased from a participating retail pharmacy or through Medco By Mail will continue in 2008:
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2008 Empire Plan Prescription Drug Program Copayment Structure* |
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Up to a 30-day supply from a participating retail pharmacy or through Medco By Mail |
Generic version of brand name drug Preferred brand name drug Non-Preferred brand name drug |
$5 $15 $30 |
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31- to 90-day supply from a participating retail pharmacy |
Generic version of brand name drug Preferred brand name drug Non-Preferred brand name drug |
$10 $30 $60 |
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31- to 90-day supply through Medco By Mail |
Generic version of brand name drug Preferred brand name drug Non-Preferred brand name drug |
$5 $20 $55 |
* If you choose to purchase a brand name drug which has a generic equivalent, you pay the non-preferred brand name copayment plus the difference in cost between the brand name drug and the generic drug, not to exceed the full cost of the drug.
The Empire Plan Prescription Drug Program will be using the enclosed 2008 Empire Plan Preferred Drug List. The Preferred Drug List includes the most commonly prescribed generic and brand name drugs that will have lower copayments. This is not a complete list of all generic and brand name prescription drugs included on the 2008 Empire Plan Preferred Drug List or covered under the Empire Plan Prescription Drug Program. Using prescription drugs that appear on this list will save you money. Using generics will save you even more. Remember only you and your doctor can decide which drugs are right for you.
If you have questions on medications that do not appear on the 2008 Empire Plan Preferred Drug List or the 2008 Preferred Drug List Alternatives or have specific questions about your prescriptions, whether the pharmacy you use is participating effective January 1, 2008, coverage or copayments, please call the Empire Plan Prescription Drug Program at 1-877-7-NYSHIP (1-877-769-7447) or visit the New York State Department of Civil Service website at www.cs.state.ny.us. Select either Employees or Retirees and follow the links to Health Benefits. Select your group and benefit plan if prompted. On the resulting NYS Online health benefits page, select “Using Your Benefits” and scroll down to the 2008 Empire Plan Preferred Drug List.
Sincerely,
Brian Kolling, PharmD.
Chief Pharmacist
UnitedHealthcare
Enclosure