PPO/EPO1/EPO2 Prescription Drug Program

www.caremark.com

1-800-421-5501

The City's prescription drug program for PPO, EPO1 & EPO2 members is through "Caremark 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 prescriptions:

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 formulary brand is prescribed and there is no generic substitute, the member will be charged 40% co-insurance. If it is non-formulary, the member will be charged 60% co-insurance. If your physician writes a precription 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.

Biotech Medications: The Plan has implemented a 4th tier for prescription drugs with a co-pay of $100 for a 30-day supply and $300 for a 90-day mail order supply. If biotech is the only option, and there are no alternative medications, then the co-pay for generic, formulary or non-formulary will apply. The $100 and $300 co-pay applies when there are other available medications.

Pain Management Program: After certain pain management drugs have been prescirbed, Caremark will aggressively manage narcotic usage including contacting the physician. As appropriate, cases will be referred for medical case management.

Non-Sedating Antihistamines: As over-the-counter alternatives exist for non-sedating antihistamines, all covered non-sedating antihistamines will be moved to the non-formulary co-insurance or co-pay tier.

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. For the "maximum" savings to your, the mail order program is mandatory for all maintenance drugs. You may gill your prescription once for retail (30-day supply only) with one refill. After that you must use the mail order program. Mail order co-pays are as follows:

CAREMARK
1-800-421-5501
Web Site: www.caremark.com
Check on prescription costs, mail orders, pricing etc. You can check status of orders and look up particular drugs.