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Medicare Part D Drug Plan
Three-Tier Copayment Structure
Tips for Reducing Out-of_Pocket Prescription Drug Costs
Prescription Drug News for Indemnity Plans (Express Scripts)
Prescription Drug News for All GIC Plans
Prescription Drug Programs
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Prescription Drug Contact Information



















 

Prescription Drug Benefits

GIC Prescription Drug Benefits
UniCare State Indemnity Plan/ Basic, Community Choice, Medicare Extension (OME) and PLUS (Express Scripts)
1-877-828-9744
GIC HMOs, Navigator by Tufts Health Plan and Harvard Pilgrim Independence Plan- Contact Your Plan

 

Three-Tier Co-Payment Structure

All GIC health plans provide benefits for prescription drugs using a three-tier co-payment structure in which your co-payments vary depending on the particular drug dispensed. The following descriptions will help you understand your prescription drug co-payment levels. Contact plans you are considering with questions about your specific medications.

Tier 1 (Generics): 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 dosage form and strength as their brand name counterparts. They cost less because they do not have the same marketing and research expenses as brand name drugs.

Tier 2 (Preferred Brand Name): 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. Costly generics may also be included.

Tier 3 (Non-Preferred Brand Name): This tier is primarily made up of brand name drugs not included in Tier 1 or Tier 2. They have generic or brand alternatives in Tiers 1 or 2.

 

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Tips for Reducing Out-of-Pocket Drug Costs

You want the best when it comes to medications, and you want to spend your money wisely.  You can do both.  The following tips will help you lower your out-of-pocket prescription drug costs:

Ask for Generics:  Ask your doctor or pharmacist if there is a generic drug that is appropriate for your condition.  By choosing a generic medication, you usually can save on your co-payment.  Generic drugs generally cost less than brand name drugs.

Give Your Doctor a Copy of Your Plan’s Formulary:  The majority of GIC plans revise their drug formularies in January and update them throughout the year.  It is available on most plan websites.  Photocopy the formulary, keep a copy for yourself and give it to each doctor that you see. 

The formulary gives you a list of the most commonly prescribed medications - generics as well as those preferred brand name drugs - with the lowest co-pays.  Frequently, there is more than one prescription drug that your doctor could prescribe for a particular illness or condition.  Discuss with your doctor whether the drugs with lower co-payments are appropriate for you.

Use Mail Order:  Are you taking prescription drugs for a long-term condition, such as asthma, high blood pressure, allergies, or high cholesterol? Switch your prescription from a retail pharmacy to mail order. It can save you money – up to one co-pay every three months. Once you begin a mail order, you can conveniently order refills by phone or Internet.   Contact your plan for details.

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Prescription Drug Programs

Some GIC plans, including the UniCare State Indemnity Plans’ prescription drug program managed by Express Scripts, have the following programs to encourage the use of safe, effective and less costly prescription drugs. Contact plans you are considering to find out details about these programs:  Contact plans you are considering to find out details about these programs:

  • Step Therapy – This program requires the use of effective, less costly drugs before more expensive alternatives will be covered.  
  • 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 co-pay.
  • Specialty Drug Pharmacies – If you are prescribed specialty medications, primarily 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 to your doctor’s office.
Important Information about Medicare Part D Active Employee Age 65 and Over:  All GIC health plans have prescription drug benefits equal to or greater than the federal Medicare Part D benefit. If you are Medicare eligible, but still working, your GIC health plan’s prescription drug coverage will satisfy Medicare’s creditable coverage requirements.

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.

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