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The City's prescription drug program for members of both the
Gold & Teal plans is through "CIGNA Tel-drug Prescription
Service". This program is not based on any deductible
charges for your medical plan. There are four tiers for prescriptions
based on the type of drug you receive. The tiers are as follows
for retail (30 day) prescriptions:
Generic: |
$5
co-pay |
Preferred
brand: |
40%
co-insurance (Min $20/Max $50) |
Non-Preferred
brand: |
60%
co-insurance (Min $35/Max $85) |
| Self
Administered Injectables/Specialty Drugs: |
$200
Copay |
Whenever
possible, request generic prescriptions from your physician.
If there is a generic available for any prescription, it will
automatically be filled using the generic drug. If a preferred
brand is prescribed and there is no generic substitute, the
member will be charged 40% co-insurance. If it is non-preferred,
the member will be charged 60% co-insurance. If your physician
writes a prescription for a brand name with a note "Dispense
as Written", you will be responsible or the brand name
co-insurance. If a brand name drug is dispensed for any reason
when a generic is available, the member will pay the generic
co-payment PLUS the difference between the
cost of the generic and the brand name drug.
Self
Administered Injectables/Specialty Drugs: The Plan
has implemented a 4th tier for prescription drugs with a co-pay
of $200 for a 30-day supply and $400 for a 90-day mail order
supply. If a specialty drug is the only option, and there
are no alternative medications, then the co-pay for generic,
formulary or non-formulary will apply. The $200 and $400 co-pay
applies when there are other available medications.
Maintenance Drugs/Mandatory Mail Order Program:
A maintenance drug is one that must be taken on a regular
basis. If you take a daily medicine, you are probably on a
maintenance medication. Your doctor will give you a one year
prescription which is filled up to 90-day increments through
the mail order service. Mail order tiers are as follows:
| Generic: |
$10
co-pay |
| Preferred
brand: |
40%
co-insurance (Min $40/Max $100) |
| Non-Preferred
brand: |
60%
co-insurance (Min $70/Max $170) |
| Self
Administered Injectables/Specialty Drugs: |
$400 |
CIGNA
Tel-drug
1-800-835-3784
Web Site: www.teldrug.com
Check on prescription costs, mail orders, pricing etc. You
can check status of orders and look up particular drugs.
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