Great West Prescriptions Coverage

Prescription drugs remain one of the leading causes of escalating health care costs. To help manage these rising costs, The City offers a three-tier prescription drug program to employees enrolled in the POS 100 Plan, POS 90 Plan, or standard PPO Plan. The program is administered by Medco. When you present your identification card at a participating pharmacy, you will be charged a co-payment, based on the type of prescription you receive.

Save With Mail Order - If you take maintenance medications for conditions such as high blood pressure, diabetes, or asthma, you can save money for yourself and the plan by purchasing your prescriptions through Medco Mail Order. For two co-payments you receive a 90-day supply, rather than a 30- day supply. You also gain the convenience of home delivery.

Note: If you enroll in the PPO Thrift Plan, you must first satisfy the plan’s deductible before receiving prescription drug benefits. After you meet the deductible, the plan pays 90% of eligible expenses at network pharmacies, or 60% at non-network pharmacies. Prescription coverage for those enrolled in the PPO Thrift Plan is administered by Express Scripts.

KEY TERMS TO KNOW:

  • Formulary – The list of drugs that the plan covers. The City’s plan features an “open” formulary, which means you may still receive benefits for prescription drugs that do not appear on the formulary, but your costs will be higher.

  • Generic – A drug that is identical in strength, concentration, and dosage form to a brand-name drug, and that generally is made available when patent protection expires on the brand-name drug. Generic drugs cost significantly less yet are chemically equivalent to their brand-name counterparts. The plan copayment for these drugs is $10 for a 30-day supply.

  • Brand Preferred – Those brand-name drugs that are named on the plan’s formulary. The plan copayment for these drugs is $25 for a 30-day supply.

  • Brand Non-Preferred – Those brand-name drugs that do not appear on the plan’s formulary. The copayment for these drugs is the higher of $40 or 30% of the actual cost. This means that if the retail cost of your prescription is $250, you would have to pay the higher of $40 or 30% of $250. Since 30% of $250 is $75, which is more than $40, your cost for the brand non-preferred drug would be $75.

* Important: If you request a brand-name drug when there is a generic equivalent, you must either purchase the generic drug, or pay 100% of the difference between the brand-name price and the generic price, plus the generic co-payment. The only exception to this rule is if your doctor writes “Dispense As Written,” or “DAW,” on your prescription, in which case the brand-name drug will be dispensed at the brand-preferred or brand nonpreferred co-payment (depending on the drug).