9.22 Eligible PS&T Unit employees enrolled in the Empire Plan will be provided with prescription drug coverage through the Empire Plan Prescription Drug Program. The benefits provided shall consist of the following:
The Prescription Drug Program will cover medically necessary drugs requiring a physician's prescription and dispensed by a licensed pharmacist.
Mandatory Generic Substitution will be required for all brand-name multi-source prescription drugs (a brand-name drug with a generic equivalent) covered by the Prescription Drug Program.
When a brand-name multi-source drug
is dispensed, the Program will reimburse the pharmacy (or enrollee) for the
cost of the drug's generic equivalent. The enrollee is responsible for the cost
difference between the brand-name drug and its generic equivalent, plus the
copayment. Effective January
1, 2005, the The enrollee will be is responsible for the cost difference between
the non-preferred brand name drug and its generic equivalent, plus the
copayment for the non-preferred brand name drug.
The copayment is $5
for up to a 90 day supply of generic drugs dispensed at either the community
pharmacy or the mail service pharmacy.
The copayment is
$15 for up to a 90 day supply of brand-name drugs dispensed at either the community
pharmacy or the mail service pharmacy.
Effective January
1, 2005, the
prescription drug program will be modified as follows:
·
A third tier of prescription drugs will be
created to differentiate between preferred and non-preferred brand-name drugs.
·
The copayment for up to a thirty-day supply at either the retail or mail
service pharmacy, will be $5 for generic drugs, $15 for preferred brand name
drugs, and $30 for non-preferred brand name drugs. Effective
·
The copayment for a 31 to 90 day supply at the retail pharmacy will be
$10 for generic drugs, $30 for preferred brand name drugs, and $60 for
non-preferred brand-name drugs. Effective
·
The copayment for a 31 to 90 day supply at the mail service pharmacy will
be $5 for generic drugs, $20 for preferred brand-name drugs, and $55 for
non-preferred brand-name drugs. Effective
Prescription drugs will be dispensed through either the preferred provider community pharmacy network (retail pharmacy), or the mail service pharmacy.
Coverage will be provided under the Empire Plan Prescription Drug Program for prescription vitamins, contraceptive drugs, and contraceptive devices purchased at a pharmacy.
Effective