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PRESCRIPTION
DRUG
COVERAGE

New For 2005:

Effective July 1, 2005, Medco will administer the Ohio Med pharmacy program.

 

Retail & Mail Order

Your health plan, whether you choose Ohio Med or an HMO, includes prescription drug coverage. As the chart below shows, your costs will vary based on where you have the prescription filled, whether you use a brand name or generic medication, and whether you obtain a formulary or non-formulary drug.

NOTE: drug and medical plans are separate and drug copays do not apply to your medical deductible or out-of-pocket maxiumum in any plan.

Retail Pharmacies
The health plans allow you to fill short-term prescriptions at local pharmacies. You pay only the required copayment and do not need to complete any claim forms.

Mail Order
Mail-order plans allow you to fill long-term or maintenance medications through the mail. Mail-order plans fill prescriptions written for 31 to 90 days. Most mail-order plans offer convenient payment methods, and prescriptions are delivered to your door. Although your copayment is higher when you use mail order, you receive a greater supply, and your total costs are lower.

Ohio Med requires you to use mail order for all refills. If you do not use mail order for refills, you pay the full cost. HMO mail-order programs are voluntary. For specific prescription drug coverage information, call your health plan directly. Plan phone numbers are shown on page the Rates and Contact Information page.

Type of Medication   Retail Prescriptions:     
up to a 30-day supply		 Mail-order Prescriptions:
up to a 90-day supply
Generic $10 copayment $25 copayment
Formulary Brand-Name Drug $20 copayment $50 copayment
Non-Formulary Brand-Name Drug $40 copayment $100 copayment
Non-Formulary Brand-Name when Generic is Available $40 copayment plus difference in price between brand-name and generic, or cost of the brand-name drug, whichever is less $100 copayment plus difference in price between brand-name and generic, or cost of the brand-name drug, whichever is less
   

Ohio Med Enrollees: Grandfathering Prescription Drug Copays

 

Effective July 1, Medco will be the new pharmacy benefit manager for the Ohio Med preferred provider organization (PPO).  Medco’s formulary is different from the current one used by Express Scripts -- there are 79 drugs that are on the Express Scripts’ formulary but not on the Medco formulary.  Employees prescribed and taking one of these drugs prior to July 1, 2005 may continue paying for the drug at the lower formulary copay level for six months beginning July 1.  This “grandfathering” period will end on January 1, 2006.   

 

This grandfathering period provides you the appropriate time to review with your doctor other cost-effective alternatives within the Medco formulary or, if available, a generic drug.

 

Links and Instructions for Health Plan Formularies


Aetna

Go to: Aetna or call 1-800-520-4785
Select: Members and Consumers

Select: Medication Formulary Guide

Select: Formulary Search

For Item #2 select: Three-Tier Copay/Open Formulary

 

Ohio Med

Call Medco Health at 1-800-903-8030. Give you drug and dosage. Representative will verify your copay amounts and alternative drugs. 79 drugs will be grandfathered until January 1, 2006.

 

UnitedHealthcare

Go to: 365 Well St. or call 1-877-442-6003

Select: Prescription Drug List

Select: 2005 Drug List

 

The Health Plan

Call 1-888-847-7902 to verify your drug copays.

 

Paramount

Go to: Paramount or call 1-800-462-3589.

Select: Member Services

Select: Prescription Drug Program

Select: Preferred Drugs

Select: 2005 Preferred Drug List

 

QualChoice

Go to: Qualchoice or call 1-800-260-2643

Select: Searchable Drug Formulary

 



What Is a Formulary?

Each health plan has a formulary, which is a preferred drug list from which your physician may prescribe. A formulary allows the plan to use competition and volume pricing to obtain the deepest discounts, and it helps keep premiums lower.

A preferred drug list usually contains several hundred medications the plan has determined to be effective and cost efficient. The formulary applies to both retail and mail-order prescriptions. In all plans, you pay higher copayments if you select a non-formulary drug.

The formulary status of the 50 most prescribed drugs for each health plan is listed here.

Facts About Generic Drugs

Did you know that:

  • When available, state employees use generic drugs 97 percent of the time.

  • Generics by law must be the same exact drug as its brand-name counterpart - the only difference is the food coloring and bonding agents that are used. Most people eat an abundance of food coloring and bonding agents in the food they eat.

  • Doctors and pharmacists agree that nearly everyone can use generics without health problems.