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Prescription Drugs

 

Get More for Less - Use Mail Order!
When you use the mail order program, you'll receive up to a 90-day supply at that same cost as a two 30-day prescriptions (a 60-day supply) at a retail pharmacy.

  

Participants in all State Medical Plans are covered under a comprehensive Prescription Drug Program.

Your prescription drug costs will vary based on:

  • Which medical plan you choose, and
  • Whether the prescription drug is a generic, a preferred brand or a non-preferred brand.

  Standard PPO and Standard HMOs Health Investor HMO and PPO

 

Retail
(up to a 30-day Supply)

Mail Order Program
(up to a 90-day Supply)

Retail and Mail Order**

Generic

$10

$20

30%

Preferred Brand Name

$25*

$50*

30%

Non-preferred Brand Name

$40*

$80*

50%

*If you choose a brand name drug when a generic equivalent is available, you pay the lesser of:

  • the brand drug copay or coinsurance, plus the difference between the plan's cost for the brand drug and the plan's cost for the generic drug, or
  • the usual retail cost of the brand drug.

**Employee cost of prescription after satisfying the appropriate individual or family annual deductible.

Generic drugs are prescription medications that have the same active ingredient formula as brand name drugs.

Preferred brand name drugs are part of a listing of preferred, clinically effective brand-name prescription drugs. Preferred lists vary by Medical Plan carrier.

Non-preferred brand name drugs are prescription medications that are not part of your Medical Plan carrier's preferred drug list.

Important Information for Retirees Regarding Medicare Part D and the State Employees' Group Insurance Program

  • Medicare Part D Prescription Drug Plans began January 1, 2006
  • The State Employees' Group Insurance Program prescription benefit is as good as or better than the Medicare Part D requirements
  • Canceling health coverage under the State Employees' Group Insurance Program will cancel both medical and prescription benefits
  • If individual retirees cancel coverage under the State Employees' Group Insurance Program, they will NOT be allowed to re-enroll at a later date
  • The State Employees' Group Insurance Program will supplement the benefits received through Medicare Part D as secondary coverage if a retiree additionally enrolls in Medicare Part D.

View a copy of the State's Medicare Part D Notice of Creditable Coverage.

For more information on Medicare Part D, please visit the Center for Medicare and Medicaid Services at http://www.cms.hhs.gov/PrescriptionDrugCovGenIn/