How does the new co-payment structure compare to the previous coinsurance structure?
Under the previous plan, members were responsible for 20% of the drug’s cost. Since the cost varies by drug, it was almost impossible to determine how much you would pay without taking your prescription to a pharmacy. Also, the 20% coinsurance could range from $4 for a drug that cost $20, to $600 for a drug that cost $3,000. Under the new plan, you will only be required to pay a fixed amount depending on the tier in which a drug is placed, i.e. you will only pay up to maximum of $35 for up to a 30-day supply of a drug that may cost $3,000. In addition, you will now exactly how much you will pay in advance. Does the prescription plan cover Over-the-Counter (OTC) Drugs? The old plan did not allow members to obtain a prescription for medications that are available “over-the-counter” (“OTC”). A drug or medication is considered to be OTC if it can be obtained without a prescription, regardless of whether or not your doctor gives you a prescription for it. In the new plan, you may request a
