Plan participants enrolled in any TRIP health plan have prescription drug benefits included in the coverage. All prescription medications are compiled on a preferred drug 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. Each level has a different copayment and/or coinsurance amount.
Participants enrolled in the Teachers' Choice Health Plan (TCHP) pay 20% of the retail cost of prescriptions, not to exceed a set maximum or be less than the set minimum copayment amount. Additionally, TCHP plan participants have a $1500 annual prescription out-of-pocket maximum. Once this out-of-pocket maximum has been met, prescriptions obtained for the remainder of the plan year will be covered at 100%.
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, 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 they are considering. Plan participants who have additional prescription drug coverage, including Medicare, should contact their plan’s PBM for coordination of benefits (COB) information.
Plan participants who have additional prescription drug coverage, including Medicare, should contact their plan’s PBM for coordination of benefits (COB) information.
Plan participants enrolled in HealthLink OAP, Aetna (formerly Coventry) OAP or the Teachers' Choice Health Plan (TCHP), have CVS/caremark as their PBM.
Under the Affordable Care Act, Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs, will be covered by the plan without cost-sharing requirements.
Below are the copayments for FY2016 through FY2018. Please note that for benefit recipients enrolled in the Teachers' Choice Health Plan (TCHP), the plan applies 20% coinsurance to the retail cost of the drug, not to exceed the maximum copayment or be less than the minimum copayment.
(30 Day Supply)
Greater of 20% OR
Lesser of 20% OR