All GIC health plans provide benefits for prescription drugs using a three-tier copayment structure in which your copayments vary, depending on the drug dispensed. The following descriptions will help you understand your prescription drug copayment levels. Contact the plans you are considering with questions about your specific medications.
Tier 1: You pay the lowest copayment. This tier is primarily made up of generic drugs, although some brand name drugs may be included. Generic drugs have the same active ingredients in the same strength as their brand name counterparts. Brand name drugs are almost always significantly more expensive.
Tier 2: You pay the mid-level copayment. This tier is primarily made up of brand name drugs, selected based on reviews of the relative safety, effectiveness and cost of the many brand name drugs on the market. Some generics may also be included.
Tier 3: You pay the highest copayment. This tier is primarily made up of brand name drugs not included in Tiers 1 or 2. Generic or brand name alternatives for Tier 3 drugs may be available in Tiers 1 or 2.
! Tip for Reducing Your Prescription Drug Costs
Use Mail Order: Are you taking prescription drugs for a long-term condition, such as asthma, high blood pressure, or high cholesterol? Switch your prescription from a retail pharmacy to mail order. It can save you money – up to one copay for three months of medication. See health plan pages for copay details. Once you begin mail order, you can conveniently order refills by phone or online. Contact your plan for details.
Prescription Drug Programs
Some GIC plans, including the UniCare State Indemnity Plans’ prescription drug program managed by CVS Caremark, have the following programs to encourage the use of safe, effective and less costly prescription drugs. Contact the plans you are considering to find out details about these programs:
- Mandatory Generics – When filling a prescription for a brand name drug for which there is a generic equivalent, you will be responsible for the cost difference between the brand name drug and the generic, plus the generic copay.
- Step Therapy – This program requires enrollees to try effective, less costly drugs before more expensive alternatives will be covered.
- Maintenance Drug Pharmacy Selection - If you receive 30-day supplies of your maintenance drugs at a retail pharmacy, you must call your prescription drug plan to tell them whether you wish to continue to use a retail pharmacy or change to 90-day supplies through either mail order or certain retail pharmacies.
- Specialty Drug Pharmacies – If you are prescribed specialty drugs - such as injectable drugs for conditions such as Hepatitis C, rheumatoid arthritis, infertility, and multiple sclerosis - you’ll need to use a specialized pharmacy which can provide you with 24-hour clinical support, education and side effect management. Medications are delivered to your home or doctor’s office.
Important Information About Medicare Part D
Medicare Retirees and Survivors
For most GIC Medicare enrollees, the drug coverage you currently have through your GIC health plan has better benefits than the Medicare Part D drug plans being offered. Therefore, you should not enroll in a Medicare Part D drug plan. See Medicare Part D section for additional details.
This information provided by the Group Insurance Commission.