Benefits - Prescription Drug Plan

Benefits

Prescription Drug Plan

Prescription drug coverage under both BluePoint and OrangePoint is administered by Medco and the cost is included in your medical plan insurance premiums. Medco is a leading pharmacy benefit manager (PBM) with the nation's largest mail order pharmacy operations.

Prescription Drug Copays/Coinsurance:

for prescriptions filled at retail pharmacies the coinsurance is 20% for generic, 20% for preferred, and 40% for non-preferred brand medications.
for prescriptions filled through mail order the copay is $20 for generic, $40 for preferred, and $80 for non-preferred brand medications.
for oral contraceptives the copay is 50% for generic and preferred brands whether purchased from a pharmacy or through mail order.

To determine if your prescription is generic, preferred, or non-preferred, check Medco's online Formulary.

Generics

To encourage the appropriate use of generics, if a generic equivalent is available and you choose to have the brand name drug, or your doctor prescribes the script "Dispensed As Written" (DAW), you will be required to pay the difference between the actual cost of the brand name drug and the amount the plan would have paid for the generic equivalent.

90 day refill program

Subscribers may fill a 90 day supply at a local participating pharmacy in addition to the mail order option. The 20%, 20%, 40% coinsurance will apply.

Biotech/Specialty drugs

Prescription drugs in the Biotech/Specialty class are required to be filled through mail order and are limited to a 30 day supply per refill. The co-pay is $20, $40, and $80, for generic, preferred, and non-preferred brand medications, respectively.

Helpful Links

Questions? Contact the HR Service Center at 443-4042 or email hrservic@syr.edu.