Page 37 - 2016-2021-OSU
P. 37

difference in cost between the generic drug and the non-preferred brand-

        name drug, plus the non-preferred brand-name copayment.

           The copayment for prescription drugs purchased at a retail pharmacy for
        a 31-90 day supply shall be as follows:

               • $10 Generic/Level One
               • $50 Preferred Brand/Level Two ($60 effective 1/1/19)

               • $90 Non-Preferred Brand/Level Three ($120 effective 1/1/19)
           When a brand-name prescription drug is dispensed and an FDA-approved

        generic equivalent  is available,  the member will be  responsible  for the
        difference in cost between the generic drug and the non-preferred brand-

        name drug, plus the non-preferred brand-name copayment.
           The copayment for prescription drugs purchased through the mail service

        pharmacy for a 31-90 day supply will be as follows:
               • $5 Generic/Level One

               • $50 Preferred Brand/Level Two ($55 effective 1/1/19)
               •$90 Non-Preferred Brand/Level Three ($110 effective 1/1/19)

           When a brand-name prescription drug is dispensed and an FDA-approved
        generic equivalent  is available,  the member will be  responsible  for the

        difference in cost between the generic drug and the non-preferred brand-
        name drug, plus the non-preferred brand-name copayment.

           (b) New-to-you prescriptions will require two 30 day fills at a retail setting

        prior  to being able to obtain  a  90 day fill through retail or mail.   This
        program will be discontinued no later than January 1, 2019.
           (c) Drugs considered to be “specialty drugs” (including but not limited to

        drugs  requiring  special handling, special administration and/or intensive

        patient monitoring and biotech drugs developed from human cell proteins
        and DNA) will be dispensed through the Empire Plan Specialty Pharmacy
        Program.

           • Enrollees may fill one prescription for a drug included in the Specialty

        Pharmacy Program at a retail pharmacy, subject to plan requirements.  After
        the initial fill at a retail pharmacy, all subsequent fills must be dispensed

        through the Specialty Pharmacy Program.
           • Drugs included in the Specialty Pharmacy Program will be assigned to

        copayment levels subject to the following copayments:
           a) for up to a 30-day supply:

               a. $5 Generic/Level One


                                                            36
   32   33   34   35   36   37   38   39   40   41   42