2012 Pharmacy Benefits for Non-Medicare Members
Introducing a Preferred Pharmacy Network for Maintenance Medications

Beginning January 1, non-Medicare HealthChoice members will have additional choices when purchasing medications. HealthChoice is introducing a preferred network of pharmacies, known as Preferred Maintenance Network pharmacies that have contracted to provide long-term, maintenance medications at discounted costs. Typically, maintenance medications are those drugs taken every day for conditions such as high blood pressure, heart disease, or diabetes.

Members can choose to fill their prescription medications through their local, retail Network pharmacy or through a Preferred Maintenance Network pharmacy. Any pharmacy that agrees to provide maintenance medications at the discounted cost can join the Preferred Maintenance Network. A complete list of the Preferred Maintenance Network pharmacies is available on this website.

If you choose to use a retail Network pharmacy, you can receive up to a 30-day supply of a long-term, maintenance or non-maintenance medication for one copay; however, after three fills of a maintenance medication at a retail Network pharmacy, your copay may be higher to reflect the difference in the price of the drug available at a Preferred Maintenance Network pharmacy versus a retail Network pharmacy. After the third fill of a long-term, maintenance medication at a retail Network pharmacy, you will be responsible for your medication copay, plus the cost difference between the Preferred Maintenance Network rate and the retail Network pharmacy rate and a $1.50 dispensing fee. Generally, the cost difference for generic medications will be minimal. Unfortunately, because of the higher cost associated with Preferred and non-Preferred medications, this cost difference will be somewhat higher depending on the price of the drug. Please note that non-maintenance medications, such as antibiotics, are not affected by these changes.

If you choose to use a Preferred Maintenance Network pharmacy, you can receive up to a 90-day supply of a long-term, maintenance medication for one copay. For example, if you take a long-term maintenance medication once per day, you can receive 90 pills or capsules; however, if you take the medication twice per day, you can receive 180 pills or capsules for one copay.

The chart below describes the new pharmacy benefits effective January 1, 2012:

Retail Network Pharmacy (non-maintenance)			Preferred Maintenance Network Pharmacy
Medication Type	Up to a 30-day supply of any medication	Up to a 30-day supply of a long-term, maintenance medication	Up to a 90-day supply of a long-term, maintenance medication
	Costs for a non-maintenance medication and the first three purchases of a long-term, maintenance medication	Cost after the third 30-day supply of a long-term, maintenance medication	Cost for up to a 90-day supply of a long-term, maintenance 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 $8.33 plus the difference between the Preferred Maintenance Network cost and the retail cost and a $1.50 dispensing fee.	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 $40 or less, you pay maximum copay of $10 or cost of drug, if less, plus the difference between the Preferred Maintenance Network cost and the retail cost and a $1.50 dispensing fee. If cost of drug is more than $40, you pay 25% of cost up to a maximum copay of $20 plus the difference between the Preferred Maintenance Network cost and the retail cost and a $1.50 dispensing fee.	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 $40 or less, you pay maximum copay of $20 or cost of drug, if less plus the difference between the Preferred Maintenance Network cost and the retail cost and a $1.50 dispensing fee. If cost of drug is more than $40, you pay 50% of cost up to a maximum copay of $40 plus the difference between the Preferred Maintenance Network cost and the retail cost and a $1.50 dispensing fee.	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.
Non-Maintenance Medications You can fill up to a 30-day supply of a non-maintenance medication at any retail Network pharmacy. No cost difference or dispensing fee applies.
Specialty Specialty medications are covered for up to a 30-day supply and only when ordered through Accredo Health. Copays are as follows: Preferred drug - $60 copay Non-Preferred drug - $120 copay
*Note:* 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 and/or quantity limitations. If you choose a brand-name medication when a generic is available, you are responsible for the difference in the cost in addition to the copay.

Last Modified on 11/18/2011

2012 Pharmacy Benefits for Non-Medicare Members Introducing a Preferred Pharmacy Network for Maintenance Medications

2012 Pharmacy Benefits for Non-Medicare Members
Introducing a Preferred Pharmacy Network for Maintenance Medications