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Prescription Drug Copays and Deductibles 

 

Plan participants enrolled in all State health plans have prescription drug coverage available. All prescription medications are compiled on a preferred list ("formulary list") maintained by each health plan's Prescription Benefit Manager (PBM). Formulary lists categorize drugs in three levels: generic, preferred brand and nonpreferred brand.  

FY15 PRESCRIPTION DRUG COPAYS & DEDUCTIBLES
Each formulary level has a different copayment amount as indicated in the chart below:
    QCHP

All Other Plans
  Generic $10

$8
  Preferred Brand $30

$26
  Nonpreferred Brand $60

$50
  Deductible $125

$100

FY14 PRESCRIPTION DRUG COPAYS & DEDUCTIBLES
Each formulary level has a different copayment amount as indicated in the chart below:
    QCHP

All Other Plans
  Generic $10

$8
  Preferred Brand $30

$26
  Nonpreferred Brand $60

$50
  Deductible $100

$75

Prescription Deductible

Prescriptions filled for participants enrolled in a managed care plan (HMO or OAP) during FY2014 have a $75 deductible; prescriptions filled for participants enrolled in the Quality Care Health Plan (QCHP) have a $100 deductible.  Beginning July 1, 2014, the prescription deductibles will be $100 per plan participant for members enrolled in a managed care plan (HMO or OAP) and $125 per plan participant for members enrolled in QCHP.  

Note: If the cost of the drug is less than the plan's copayment, the plan participant will pay the entire cost of the drug, all of which will be applied toward the deductible.

Coverage for specific drugs may vary depending upon the health plan. It is important to note that formulary lists are subject to change any time during the plan year. To compare formulary lists (preferred drug lists), cost-savings programs and to obtain a list of pharmacies that participate in the various health plan networks, plan participants should visit the website of each health plan. Certain health plans notify plan participants by mail when a prescribed medication they are currently taking is reclassified into a different formulary list category. Plan participants should consult with their physician to determine if a change in prescription is appropriate.

Updated 04/29/14