2012 HealthChoice Pharmacy Benefits for Pre-Medicare Members

During its December 16 meeting, the Oklahoma State and Education Employees Group Insurance Board adopted new pharmacy benefits for Plan Year 2012. The new benefits will reduce costs for both the HealthChoice plans and plan members.

Members can fill prescriptions for up to a 90-day supply at all HealthChoice Network Pharmacies at the same cost. The HealthChoice Pharmacy Network includes both independent and national chain pharmacies.

To view the list of preferred medications, see the HealthChoice Select Medication List or contact Medco toll-free at 1-800-903-8113. TDD users call toll-free 1-800-825-1230.

The chart below provides a summary of the pharmacy benefits for 2012:

Network Pharmacy Benefits for Pre-Medicare Members
Medication Type	Up to a 30-day supply of a medication	Up to a 90-day supply of a medication
Generic	You pay cost of drug up to a maximum copay of $10.	You pay cost of drug up to a maximum copay of $25.
Preferred brand-name	If cost of drug is $60 or less, you pay maximum copay of $15 or cost of drug, if less. If cost of drug is more than $60, you pay 25% of cost up to a maximum copay of $30.	If cost of drug is $120 or less, you pay maximum copay of $30 or cost of drug, if less. If cost of drug is more than $120, you pay 25% of cost up to a maximum copay of $60.
Non-Preferred brand-name	If cost of drug is $60 or less, you pay maximum copay of $30 or cost of drug, if less. If cost of drug is more than $60, you pay 50% of cost up to a maximum copay of $60.	If cost of drug is $120 or less, you pay maximum copay of $60 or cost of drug, if less. If cost of drug is more than $120, you pay 50% of cost up to a maximum copay of $120.
Specialty medications are covered for a 30-day supply when ordered through Accredo Health. Copays are as follows: Preferred drug - $60 copay Non-Preferred drug - $120 copay
All Plan provisions apply. Only costs for Preferred medications purchased at Network Pharmacies apply to the annual $2,500 out-of-pocket limit. Some medications are subject to prior authorization, quantity limitations, or other Plan provisions. If you choose a brand-name medication when a generic is available, you are responsible for the difference in cost in addition to the copay.
HealthChoice S-Account Plan – The pharmacy benefits above apply after the combined medical and pharmacy deductible ($1,500 individual/$3,000 family) has been met.

Non-Network Pharmacy Benefits
Preferred Medication	Non-Preferred Medication
If cost of medication is $90 or less, you pay maximum copay of $45 or cost of medication, if less, plus dispensing fee. If cost of medication is more than $90, you pay 50% of ingredient cost, plus dispensing fee (no maximum).	If cost of medication is $160 or less, you pay maximum copay of $120 or cost of medication if less, plus dispensing fee. If cost of medication is more than $160, you pay 75% of ingredient cost, plus dispensing fee (no maximum).
All Plan provisions apply. Only costs for Preferred medications purchased at Network Pharmacies apply to the annual $2,500 out-of-pocket limit. Some medications are subject to prior authorization, quantity limitations, or other Plan provisions. If you choose a brand-name medication when a generic is available, you are responsible for the difference in cost in addition to the copay.
HealthChoice S-Account Plan – The pharmacy benefits above apply after the combined medical and pharmacy deductible ($1,500 individual/$3,000 family) has been met.

Last Modified on 12/05/2012