Generic drugs cost consumers less The cost of prescription drugs is one of the fastest-growing components of the U.S. health care system. The Empire Plan prescription drug benefit is designed to help manage drug costs and establish co-payment levels that are more in line with the relative cost of various drugs to the Plan. While there are co-payment requirements under The Empire Plan, the plan continues to pay most of the cost of covered prescription drugs. The Empire Plan Prescription Drug Program has three levels of co-payments. An enrollee’s co-payment depends on the drug, the quantity supplied and where the prescription is filled. A list of the current co-payment amounts for CSEA represented employees covered under the Empire Plan is on this page. To help keep your out-of-pocket costs as low as possible, let your doctor know that your Empire Plan co-payments are lower when you use generic and/or preferred brand-name drugs. Why generic drugs? Most generic drugs have the same active ingredients, strength and dosage form (pill, liquid or injection) as their brand-name counterparts. The U.S. Food and Drug Administration (FDA) approves generic drugs for safety and effectiveness. Use of generic drugs usually results in the enrollee being responsible to pay the lowest copayment. What is a preferred brand-name drug? Under the Empire Plan, a preferred brandname drug usually has no generic equivalent and has been determined by the plan administrator to be a better value than its therapeutic alternatives. The co-payment for preferred-brand name drugs is typically higher than a generic drug, however, lower than a non-preferred drug. For specific information about your out-ofpocket requirements under The Empire Plan prescription drug program, call The Empire Plan toll free at 1-877-7-NYSHIP (1-877-769- 7447) and choose #4 for The Empire Plan Prescription Drug Program. On the road with the Empire Plan Spring is finally here, and that means summer is right around the corner. As the weather warms up, you begin to plan taking your family on that trip this summer. Before you go, however, plan ahead. Do you have your doctor’s phone number and your Empire Plan Benefit Card? Do you have enough of your regular medications? If you are Medicare primary, do you also have your Empire Plan Rx card? And, don’t forget to pack On the Road with The Empire Plan. It has important information and phone numbers. Empire Plan coverage is available worldwide, and not just for emergencies. Most parts of The Empire Plan have two levels of benefits. If you use an Empire Plan participating provider, you will receive medically necessary covered services and supplies at little or no cost and have no claim forms to fill out. If you use a non-participating provider, medically necessary services and/or supplies are covered, but deductibles, coinsurance and benefit limits may apply. Know your plan and how it works away from home. Request an updated version of On the Road with The Empire Plan from your agency health benefits administrator, or if you are a retiree, contact the Civil Service Employee Benefits Division at 1-800-833-4344 for a printed copy. This informative booklet includes contact information for Empire Plan programs as well as valuable tips for getting the most out of your coverage while you’re away from home. It can also be found online at www.cs.ny. gov. Click Benefit Programs, then NYSHIP Online, and then Using Your Benefits. Click on Publications, and On the Road with The Empire Plan will be listed there. Right, the cover of the On the Road with the Empire Plan booklet. Empire Plan Prescription Drug Program co-payments Up to a 30-day supply of a covered drug from a Network Pharmacy or through the Mail Service Pharmacy, or designated Specialty Pharmacy: $ 5 Level 1 or for most Generics $25 Level 2 or Preferred Drugs $45 Level 3 or Non-Preferred Drugs 31 to 90-day supply of a covered drug from a Network Pharmacy: $10 Level 1 or for most Generics $50 Level 2 or Preferred Drugs $90 Level 3 or Non-Preferred Drugs 31 to 90-day supply of a covered drug through the Mail Service Pharmacy or designated Specialty Pharmacy: $ 5 Level 1 or most Generics $50 Level 2 or Preferred Drugs $90 Level 3 or Non-Preferred Drugs 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 nonpreferred brand-name drug, plus the nonpreferred brand-name co-payment. 16 The Work Force May 2014
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To see the actual publication please follow the link above