Prescription Drug Plan: Coverage Overview

Eligible Employees

The Prescription Drug Plan is offered to employees who enroll in the Research Foundation Regular Health Plan (PPO). Employees participating in a Health Maintenance Organization (HMO) are not eligible for the Prescription Drug Plan described in this document.

Plan Administrator

The Prescription Drug Plan is provided through Medco.

Description of Programs

Prescription drug coverage is available through the following sources:

Retail Pharmacy

Short-term or emergency prescription drugs can be purchased from a participating or nonparticipating pharmacy. Employees present their ID card when using a participating pharmacy or complete a claim form when using a nonparticipating pharmacy. Refer to "Your Prescription Drug Benefit Handbook" for more information.

Medco By Mail

Employees have their prescriptions filled through the mail when using Medco By Mail. This source is normally used for long-term prescriptions. Refer to your "Your Prescription Drug Benefit Handbook" for more information.

Costs to the Employee

The copayment schedule can be found in "Your Prescription Drug Benefit Handbook"

Quantities

An employee can get up to a 90-day supply in a single prescription through the mail service but only up to a 30-day supply at a retail pharmacy.

What Drugs Are Covered

Drugs that require a prescription under state or federal law are covered (refer also to the next section of this document "What Drugs Are Not Covered").

Generic

Generic prescription drugs are covered through retail or mail service (reimbursement may be less when using a nonparticipating pharmacy through the Medco Health Prescription Program).

Brand-Name

Brand-name drugs are covered through retail or mail service. If a doctor prescribes a brand-name drug when a generic equivalent is available, the employee must pay the difference in cost between the generic and brand-name drug.

Fertility Drugs

Medications used for treating infertility are subject to a 50 percent coinsurance for both retail and mail order prescriptions.

What Drugs Are Not Covered

The following drugs are not covered under either program:

cosmetic drugs, including drugs for hair growth
drugs and medical supplies available over the counter
vitamins
food supplements, except those required for the treatment of phenylketonuria, branched-chain ketonuria,galactosemia,
and homocystinuria
(these require special claim handling).
non-oral contraceptives
drugs not approved for use under federal or state law
health and beauty aids
experimental or investigational drugs
drugs dispensed in a hospital or other medical facility
drugs covered by Workers’ Compensation or by a drug / medical service which does not charge the employee
immunization agents, biological sera, blood or blood plasma
refills in excess of the number of refills specified by the physician
any drug dispensed after one year from the original prescription date
erectile dysfunction drugs in excess of 12 tablets per 30-day supply (not covered for males under age 18)

Change History

February 14, 2003 - Converted and updated be-a-40 (January 1, 2000) from Benefits Manual.
June 2, 2005 - Revised with prescription drug program changes.

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