Prescription Drug Changes — Actives OnlyDecember 26, 2013
Compliance with the recent Federal Patient Protection and Affordable Health Care Act (PPACA) will cost the Active Fund $1 million in additional costs with no additional funding. This law also requires the elimination of our $10,000 annual plan spending limit per family and also covering certain preventative drug categories at no cost to the member.
As such, a new active member prescription drug co payment structure will go into effect on January 1st, 2014. Generics will continue to have a $0 member co payment. Preferred brand name drugs will have a 25% member co payment and non-preferred brand name drugs will have a 50% member co payment. Additionally, all brand name psychotropic and asthma medications will require a 45% co payment. Members will continue to be responsible for the cost differential between brand and generic medications, in addition to the co payment, when a brand name medication is selected over a generic.
The DEA will implement a Step Therapy program for all prescription drugs and require that all Specialty Medications be filled at Benecard’s Central Fill Mail Order Pharmacy with the initial prescription to be filled (1) time at a retail pharmacy. Please refer to the Benecard letter and plan change brochure that was mailed to each of our active members.