Outpatient Prescription Drugs
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Self funded by the Plan through Pharmaceutical Care Network (PCN) network pharmacies and Certifax Mail Service pharmacy.
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| Generic Drugs | Brand Name Drugs 1 | |
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Certifax Mail Order Service 2 | $3 copay per 90-day supply | $10 copay per 90-day supply | |
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| 90-day supply maximum | |
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Medications obtained 2 at pharmacies using PCN card | 80% of negotiated price | 70% of negotiated price | |
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| 30-day supply maximum | |
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Medications obtained without using PCN card or obtained at a non-PCN pharmacy | 50% of retail cost | |
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1. Benefit when no generic equivalent exists. If a generic equivalent exists but is not dispensed, the Plan pays only the benefit which would have been paid if generic had been dispensed. The patient will pay the difference between the brand name and the generic drug.
2. Oral contraceptives (birth control pills) are covered for a 30-day supply at retail (walk-in) pharmacies only. They are not available through Certifax Mail Service.
Note: If you are covered under a Medicare HMO plan, your prescriptions must be obtained through that carrier. For copay reimbursement information, please refer to page 33
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