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. The enrollee is responsible for the cost difference between the non-preferred brand name drug and its generic equivalent (ancillary charge), plus the copayment for the non-preferred brand name drug. • The copayment for up to a 30-day supply at either the retail, specialty or mail service pharmacy will be $5 for generic/Level One drugs, $30 for preferred brand/Level Two drugs and $60 for non-preferred brand/Level Three drugs. • The copayment for a 31 to 90 day supply at the retail or specialty pharmacy will be $10 for generic/Level One drugs, $60 for preferred brand/Level Two drugs and $120 for non- preferred brand/Level Three drugs. • The copayment for a 31 to 90 day supply at the mail service pharmacy will be $5 for ge- neric/Level One drugs, $55 for preferred brand/Level Two drugs and $110 for non-pre- ferred brand/Level Three drugs. • 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 pre- scription vitamins, contraceptive drugs, and contraceptive devices purchased at a phar- macy. * A medical exception program is available for non-formulary prescription drugs that are excluded from coverage. If a physician’s request for a medical exception is approved, the Level One copayment will apply for generic drugs and the Level Three copayment will apply for brand-name drugs. * A Dispense as Written exception request is available for medically necessary prescription non-preferred brand-name drugs that have a generic equivalent. If a physician’s request for medical necessity is approved, the L...
Eligible PS. T Unit employees enrolled in a Health Maintenance Organization participating in the State Health Insurance Plan will be provided with prescription drug coverage through the HMO in which they are enrolled.
