Prescription Drug Program

 

The member, his or her spouse, and children (up to their 26th birthday) can use the Benecard PBF drug card at participating pharmacies with a co-payment schedule as follows:

$ 0 (zero) for generic medications

25% for preferred brand name medications

50% for non-preferred brand name medications

45% for ALL brand name psychotropic and asthma medications

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.

A Step Therapy Program has been implemented effective January 1, 2014 for all therapeutic drug categories including specialty medications. This program applies only to new prescriptions for medications requiring step therapy.

 

Prescription drugs that have an over-the-counter equivalent are not covered under our drug plan.

In accordance with the Patient Protection and Affordable Care Act (PPACA) dependent children from the ages of 19 to the date of their 26th birthday may use the Benecard PBF card to obtain their prescriptions, and simply pay the co-payment. Dependent student verification is no longer required for prescription drug benefits under PPACA.

Please note: Dependent student verification IS required for all other (non-prescription drug) DEA health benefits that are classified as "non-essential" under PPACA. As such, children from the ages of 19 to the date of their 23rd birthday (who have proper student verification on file with the DEA) will be covered for these benefits. Student verification must be submitted to the DEA Health Benefits Office 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 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 medications

25% for preferred brand name medications

50% for non-preferred brand name medications

45% for ALL brand name psychotropic and asthma medications

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.

 

Effective August 18, 2014, Specialty medications are no longer covered under our Active members drug plan.  Active members who utilized specialty medications on or prior to June 19, 2014 were grandfathered for those medications only and will continue to be covered under the DEA prescription drug plan.  The same 25% and 50% co-payments will apply for preferred and non-preferred specialty medications, respectively.

Effective January 1, 2014, once the prescription drug spend reaches $10,000 per calendar year per family, all medications (both brand and generic) will be covered at 50%. Members with individual coverage will have a $6,350 annual out of pocket maximum. Members with family coverage will have a $12,700 annual out of pocket maximum. Once out of pocket maxima are reached, the DEA will cover 100% of the cost of the medication.

In addition, with the inception of the Patient Protection and Affordable Care Act (PPACA), certain preventative drug categories will now be covered with certain restrictions. Please refer to the Benecard benefit summary mailed to your home for further details.

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

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 –

1.Ascertaining the complete ten digit "line of duty injury" number from the approved LOD report that relates to the prescription required for that injury.
2.Obtain the "line of duty" prescription paper card from the LOD package and enter on the card your tax registry number and the ten digit approved line of duty number.
3.Present to the participating pharmacy your prescription along with the "line of duty" program card bearing your tax registry number and the line of duty number.
4.Present to the pharmacist your NYPD identification card.

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:

1.The Member's six digit tax registry number; 
2.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
3.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:

1.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; 
2.An initial five (5) day supply is limited for high cost medications; 
3.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:

1.Envision Rx Options' 24-hour help desk at 1 (866) 909-5167;

2.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;

3.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:

1.The Medical Division;

2.Via fax by contacting Envision Rx Options' 24 hour help desk at 1 (866) 909-5167;

3.On the NYPD intranet website at www.nyc.gov/nypd in the "Finest Health" link (user name is "finesthealth" and password is "stayhealthy");

4.Download a copy of the card by clicking on this link. Card may be printed from your computer and/or photocopied

Last modified on Monday, 06 October 2014 11:35