Prescription Coverage

Effective January 1, 2009, each health plan participant (members and dependents) will be required to pay a prescription deductible each plan year. Once the deductible has been satisfied, individuals will not be required to meet the deductible again until the beginning of the next plan year.

Plan participants enrolled in any of the State health plans have prescription drug coverage included in their health plan benefits. Prescription benefits are administered by the health plan's Prescription Benefit Manager (PBM). Members who use the PBMs pharmacy network to obtain their medication will be charged the applicable prescription co-payment after the prescription deductible has been met. A pharmacy that is not in the network may charge more than the co-payment amount; therefore, members should verify that a pharmacy is in network in order to avoid high prescription costs.

Most health plans also offer mail order and/or maintenance medication programs. Plan participants who use a maintenance medication (such as medication for high blood pressure or high cholesterol) may receive an enhanced benefit by using these programs. Check with your health plan to see if they offer these types of programs.