Health Plan at-a-glance: Prescription drug benefits
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The AFTRA Health Plan provides prescription drug coverage with copayments and a separate deductible for retail pharmacy purchases. See the chart at the bottom of this page for more information. To achieve maximum savings, utilize Medco Pharmacy mail order services and choose generic drugs and  whenever possible. The Food and Drug Administration requires that generic equivalent medications have the same quality, safety and effectiveness as their brand name counterparts. 

Retail pharmacies1
Copayments
  • Generic drugs up to a 30-day supply
$10
  • Brand name drugs up to a 30-day supply
25% of the total prescription cost.
  • Brand name with generic equivalent up to a 30-day supply
25% of the total prescription cost, plus entire difference in cost between the brand name and generic.
 Annual deductible  
  • Retail pharmacy
    prescription drug purchases
  $75 annual deductible per individual / $150 maximum per family
Medco Pharmacy (mail order)
Copayments
  • Generic drugs up to a 90-day supply
$30
  • Brand name drugs up to a 90-day supply
25% of the total prescription cost, with a $150 maximum per prescription.
  • Brand name drugs with generic equivalent up to a 90-day supply
25% of the total prescription cost, with a $150 maximum per prescription, plus the entire difference in cost between the brand name and generic.
Annual deductible  
  • Medco Pharmacy (mail order) 
    prescription drug purchases
 No annual deductible
All pharmacies
Annual out-of-pocket maximum $2,0002,3  plus deductible.

 
1 Purchases from retail pharmacies are only covered for short-term medications and initial purchases of long term or specialty medications. See requirements for long-term and specialty medications below.

2 The difference in cost between brand name drugs and their generic equivalents (when they are available) is considered a non-covered expense. When participants elect to purchase brand names over available generic equivalents they are responsible for the cost differential.  Such costs are not included in the out-of-pocket maximum.

3 Also, if you use a non-network retail pharmacy, you will have to pay the difference between the retail amount charged by the pharmacy and 
the amount you would have been charged if you used a network retail pharmacy. This difference between network and non-network pharmacy 
charges is not applied toward or subject to the annual out-of-pocket maximum.

Requirement for coverage of long-term medications
Effective Jan. 1, 2011, participants are required to use Medco Pharmacy for long-term medications (medications taken for three months or more, such as those used to treat high blood pressure or high cholesterol). Each prescription for a long-term medication may be filled up to twice at a network retail pharmacy, with the applicable retail co-payment. All subsequent prescriptions for each long-term medication must be filled through Medco Pharmacy. If you continue to purchase a long-term medication at a retail pharmacy after the first two fills at a retail pharmacy, you will pay the entire cost of the medication. 

If you're new to Medco Pharmacy, or for more information, learn how to get started at our Medco Pharmacy Web page. For more information about the prescription drug program requirements, view the Medco Pharmacy FAQs, the September 2010 Benefits Update and the 2011 Health Plan SPD. 

Requirement for coverage of specialty medications
Also effective Jan. 1, 2011, participants must fill prescriptions for specialty medications (drugs used to treat a broad array of complex diseases that may require special handling, administration by infusion or injection, or specialized patient support) through Accredo specialty pharmacy. Each prescription for a specialty medication may be filled once at a network retail pharmacy, with the applicable retail copayment. All subsequent prescriptions for each specialty medication must be filled through Accredo. If you continue to purchase a specialty medication at a retail pharmacy after the first fill at a retail pharmacy, you will pay the entire cost of the medication.

Learn more about Accredo's specialty pharmacy services by viewing our Accredo Health Group Web page, the Accredo specialty pharmacy FAQs, the September 2010 Benefits Update and the 2011 Health Plan SPD.


Refer to the 2011 Health Plan SPD and relevant Benefits Updates for additional information. for additional information and details about the Plan's prescription drug benefits.The information provided above is summarized and is not a complete description of the actual terms and provisions of the Health Plan documents.If any conflict arises between this information and the Plan documents, or if any point is not discussed above or is only partially discussed, the Plan documents will govern in all cases.