Active Member Prescription Benefit
Benefit Summary
- $5 co-payment for drugs with a cost up to $25
- 15% co-payment for all drugs costing more than $25
- Mandatory generic, if member elects to purchase brand, the member must pay the difference in price between generic and brand
- $15,000 annual family cap not including member co-payments
Prescription Cards
Upon notification of member's promotion to lieutenant, the SOC issues a prescription card for member, spouse and/or each dependent child. If a prescription card is lost, a request for a new card must be made in writing via mail or fax: 212-406-3105.
Mail-order Maintenance Prescriptions
The member has no co-payment for maintenance drugs secured through the Central Fill Mail Order. Prescriptions are filled through this service in 6 month supplies and mailed in three month increments. The prescription must indicate a 3 month supply with one refill. If the member opts for brand over generic, he/she will be charged the difference in price.
PICA Drug Coverage
Effective July 1, 2005, injectables and chemotherapy medications will continue to be covered through the PICA program and be administered by NPA. Psychotropic and Asthma medication will no longer be available through the PICA program. These medications can be obtained through the SOC prescription program. To contact NPA call: 800-467-2006
Exclusions
Certain medications are not covered by the SOC prescription plan including, but not limited to:
- injectables
- chemotherapy medication
- hormones
- Diabetes medication (must be obtained through the member's underlying health care plan)
- fertility medications
- off label (non-FDA approved) usage
- appliances
For more specific information about prescription coverage exclusions, please call: 800-839-8442.