Prescription Drug benefits
What are the Network pharmacy benefits?
Once you have satisfied the deductible, you pay as follows:
| | Medco by Mail | Retail pharmacy** |
| | Up to 90-day supply | Up to 30-day supply |
| Generic drugs | $30 per fill | $10 when purchased at a participating retail pharmacy |
| Brand name drugs | 25% with a $150 maximum per fill | 25% when purchased at a participating retail pharmacy |
| Brand name drugs with a generic equivalent | 25% with a $150 maximum per fill, plus the entire difference in cost between the brand and the generic. | 25% when purchased at a participating retail pharmacy, plus the entire difference in cost between the brand and the generic. |
** At a non-Network pharmacy, you also pay the difference between the discounted price and the actual charge.
For additional information, refer to the December 2008 Benefits Update.
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What are the non-Network pharmacy benefits?
At a non-Network pharmacy, you pay the full retail price, and then submit a claim for reimbursement to Medco. Claim forms are available from Medco Member Services by calling 1-800-903-8343. Once you have satisfied the deductible, you pay the same copayments that apply to Network pharmacy benefits, plus the difference between the discounted price and the actual charge.
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Is there a deductible for the Prescription Drug Program?
Yes. The retail deductible is $75 for an individual and $150 for a family. Mail order service purchases are not subject to, and do not count toward, the deductible.
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How does the prescription drug mail order service work?
There is no deductible. You pay the applicable copayment per prescription and you can receive up to a 90-day supply of medication. Simply send in your prescription(s) and payment in the pre-addressed mail order service envelope. Mail order service envelopes are available from Medco Member Services by calling 1-800-903-8343. You should use the mail order service for any maintenance medications. Be sure to send in the order at least two weeks in advance of when you need it.
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If I lose my medication or need an early refill, what should I do?
The AFTRA Prescription Drug Program has an “early refill option” that allows you to order prescriptions in advance for the normal supply allowed. If you need a prescription refilled early due to special circumstances (such as losing your medication or going on vacation), contact Medco Member Services at 1-800-903-8343.
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