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Prescription Drug Coverage
If you enroll for medical coverage, you will automatically receive prescription drug benefits. Most plans include Medco prescription drug coverage for you and your covered dependents. To review your pharmacy benefits and use the Medco Savings Advisor to learn how you may save money on prescriptions, click here.
There are two types of prescription drug benefits: retail pharmacy benefits and Medco by Mail prescription benefits. For a list of covered prescription medications under the Medco Health Prescription Drug Plan, please refer to the Medical Plan Summary Plan Description. You may also call Medco Health Member Services or visit www.medcohealth.com to determine if your prescription medication is covered under the plan.
If you enroll in Health Alliance Plan, any of the Kaiser HMO plans, or are currently enrolled in BlueCross BlueShield of Alabama, your HMO will provide prescription drug coverage.
Here is a summary of the key benefits for both the Retail Pharmacy and Medco by Mail prescription drug benefits.
Retail Pharmacy
(local drug store) |
Employee Cost
Generic
Brand-name |
20% of cost ($10 minimum/$50 maximum)
30% of cost ($20 minimum/$75 maximum)
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Maximum Supply per Prescription
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30-day Supply |
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Retail Refill Limits
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For maintenance medications, your first three (3) 30-day supply retail fills are at the standard retail pricing. Subsequent retail fills are at the 50% coinsurance with no price maximum.
By utilizing Medco by Mail, you will receive the discount applicable to a 90-day supply. See Medco by Mail for more information. (Oral contraceptives and prenatal vitamins are excluded from retail refill limits.)
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Quantity Dispensing Event (QDE) Limits
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QDE limits ensure only the necessary medication for an entire course of therapy is dispensed. For example, if your prescription states to take one pill a week for 4 weeks, then you will only receive 4 pills.
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| Medco by Mail |
| Maximum Supply per Prescription |
90-day Supply
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Employee Cost
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- $25 copay
- 30% of charges ($50 minimum/$125 maximum)
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If you choose mail order brand-name drugs, you’ll make a coinsurance payment. Coinsurance is the cost of health care services that you and the plan share each time you receive a service. For mail order brand-name drugs, you are responsible for paying 30% of charges, subject to a $50 minimum and $125 maximum. VZW pays 70% of charges and anything above the $125 maximum.
The table below outlines a few examples of how the coinsurance provision works.
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$150
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30% of $150 = $45
Since $45 is below the $50 minimum, you pay $50
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$100
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$200
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30% of $200 = $60
You pay $60
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$140
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| $450 |
30% of $450 = $135
Since $135 is above the $125 maximum, you pay $125 |
$325 |
My Rx Choices
Through Medco, you have access to My Rx Choices, which compares the drugs you are currently taking and suggests lower-cost alternatives that may save you money.
Using My Rx Choices is easy. Visit the Medco website at www.medco.com, select “My Rx Choices,” and confirm the medications you are taking. With this tool, you can view all prescription choices and make informed decisions about lower-cost alternatives based on your prescription plan and your prescription history.
Ask your doctor to consider prescribing a lower-cost option if one is available, such as a generic. Medco may be able to contact your doctor on your behalf, and in such cases, you’ll be notified of any changes or new prescriptions that your doctor approves. No prescription is ever changed without your doctor’s approval.
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