DRUG PROGRAM – ACTIVES -- Mandatory Generic Reimbursement
The member, his or her spouse, and children (up to their 23rd birthday) can use the Benecard PBF drug card at participating pharmacies with a co-payment schedule as follows:
$ 0 (zero) for generic prescriptions
15% for preferred brand name and specialty drugs
40% for non-preferred brand name and specialty drugs
If a member obtains a brand name drug that has a generic available, he or she will also pay the cost difference between the brand name and the generic.
There is a $10,000 cap for a family per year. Prescription drugs that have an over-the-counter equivalent are not covered under our drug plan.
Children from the ages of 19 to the date of their 23rd birthday (who have proper student verification on file with the DEA) will now be eligible to use the Benecard PBF card to obtain their prescriptions, and simply pay the co-payment. Student verification must be submitted to the DEA twice each year for the fall and spring sessions. Please remember to submit student verification for the fall semester (which covers the time period between 9/1 and 2/28), and the spring semester (which covers the time period between 3/1 and 8/31). Click here for the DEA Student Verification Form.
Mail order -- The maintenance (continuous medication) drug program entitles you to a three (3) month supply with a co-payment schedule per prescription as follows:
$ 0 (zero) for generic prescriptions
15% for preferred brand name and specialty drugs
40% for non-preferred brand name and specialty drugs
If a member obtains a brand name drug that has a generic available, he or she will also pay the cost difference between the brand name and the generic.
You may contact Benecard PBF directly at 1-888 DEA NYPD or the DEA health benefits office should you have any questions regarding your prescription drug benefits.
The City of New York is covering certain prescriptions (injectibles and chemotherapy drugs) under the PICA program. This program is available to all non-Medicare members who are enrolled in a City-sponsored Health Plan The benefit is administered by Express Scripts and requires the member to present their Express Scripts PICA card at the pharmacist. Contact the DEA office or call Express Scripts at (800) 467-2006 for more information. You may also visit Express Script’s web site at www.express-scripts.com
Click here to download the Benecard Services Direct Reimbursement Claim Form
Click here to download the Benecard PBF Mail Order Form
Click here to download a list of the Top 10 Brand Name Drugs and their Generic Equivalents.
LINE OF DUTY PRESCRIPTION DRUG PROGRAM
The NYPD Medical Division assumes the responsibility for payment of prescription medicines related to “approved” line of duty injuries for active uniformed Members of the Service. The program is administered by Envision RxOptions Incorporated and there are no co-pays or deductibles for injured members concerned.
Injured members can receive free prescription medication for their line of duty injuries
by –
NOTE – There is no need for any pharmacist to copy your NYPD identification card in order to fill your prescription!
Members should familiarize themselves with NYPD Operations Order # 36 of 2008 for details.
Here are some frequently asked questions:
Q. Who can use the Line-of-Duty Prescription Program?
A. Only uniformed members of the NYPD who are
still active and who have sustained an “approved”
line of duty injury, and have
a valid prescription from a licensed practitioner for medication(s)
to treat
that injury.
Q. What do I need to use the Line-of-Duty Program?
A. Four items are needed to utilize the Line-of-Duty Program:
- The Member’s six digit tax registry number;
- A valid 10 digit Line-of-Duty Injury Number (specific to the injury that requires medication); A Line-of-Duty Prescription Program Card (fill in the 16 digit card-holder number with your tax registry number plus your Line-of-Duty Injury number); and
- The valid prescription intended to treat the Line-of-Duty injury.
Q. Are there any restrictions or limitations to the Line-of-Duty Prescription Program?
A. Yes:
- The Line-of-Duty Prescription program is a mandatory generic drug program. If a generic drug is available, then the brand name drug is not covered;
- An initial five (5) day supply is limited for high cost medications;
- Other clinical and cost containment safeguards are administered (quantity limits, step therapy, prior authorization, refill too soon, drug to drug interactions, etc.).
Q. Who can I call if I have questions about the Line-of-Injury Prescription Program?
A. Uniformed Members of the Service who
require help or guidance with any aspect of the Line-of-Duty
Prescription Drug
Program can contact the following:
- Envision Rx Options’ 24-hour help desk at 1 (866) 909-5167;
- The Medical Division’s Line-of-Duty Prescription Drug Unit, Monday through Friday, from 07:00 to 18:00 hours, at (718) 760-3029 or (718) 760-3059;
- The Medical Division’s Sick Desk Supervisor (24 hours per day) at (718) 760-7606.
Q. Where can I get a Line-of-Duty Prescription Program Card?
A. Blank cards are not individual specific and are available at the following:
- The Medical Division;
- Via fax by contacting Envision Rx Options’ 24 hour help desk at 1 (866) 909-5167;
- On the NYPD intranet website at www.nyc.gov/nypd in the “Finest Health” link (user name is “finesthealth” and password is “stayhealthy”);
- Download a copy of the card by clicking on this link. Card may be printed from your computer and/or photocopied.