Open Enrollment

Retail and Mail Order

Your heath plan, whether you choose the Ohio Med PPO 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.

Retail Pharmacies
The health plans allow you to fill prescriptions for up to a 30-day supply 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 on-going or maintenance prescriptions 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 utilization of mail order for all refills of a medication after your second retail fill of that prescription. If mail order is not utilized for refills, then you may pay the full cost of the prescription. Ohio Med enrollees should contact Medco for any question regarding their drug coverage.

HMO mail-order programs are voluntary. Contact your HMO for specific drug coverage information regarding your prescription drug program.


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10 PRESCRIPTION DRUG COVERAGE New for June 2006 to July 2007: • Effective July 1, 2006, Ohio Med enrollees may fill a new prescription and one refill at a retail pharmacy. An employee must have the first prescription filled on or after July 1, 2006.	Retail and Mail Order Your heath plan, whether you choose the Ohio Med PPO 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. Retail Pharmacies The health plans allow you to fill prescriptions for up to a 30-day supply 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 on-going or maintenance prescriptions 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 utilization of mail order for all refills of a medication after your second retail fill of that prescription. If mail order is not utilized for refills, then you may pay the full cost of the prescription. Ohio Med enrollees should contact Medco for any question regarding their drug coverage. HMO mail-order programs are voluntary. Contact your HMO for specific drug coverage information regarding your prescription drug program.



		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 helps keep premiums lower. A formulary usually contains several hundred medications the plan has determined to be effective and cost efficient. When possible, discuss with your physican about being prescribed medications that are included in the formulary — this will ensure that you will be paying the lowest possible cost. The formulary applies to both retail and mail-order prescriptions. For all plans, your doctor may prescribe non-formulary drugs which will result in a higher copay for you. You can obtain the formulary list from your plan and/or on the pharmacy benefit manager’s Web site or by clicking here. Did You Know? • When available, state employees use generic drugs 97 percent of the time. • Generics, by law, must be the same exact drug as their brand-name counterpart. The only difference is the food coloring and bonding agents that are used. • Doctors and pharmacists agree that nearly everyone can use generics without adverse side effects. • You can lower your overall prescription drug costs through the use of generic medications. • The lowest possible co-payment is applied to all generic medications. Consider asking your physician if there is a generic medication available to treat your condition.
	The chart below is a sample list of the 20 most commonly prescribed brand-name maintenance drugs. The formulary status for each plan is indicated by a "Yes" or "No" for each drug.