Retired Member Prescription Benefit
Benefit Summary
- $150 yearly deductible total for member and spouse
- No prescription coverage for dependent children
- $5 co-payment for drugs with a cost up to $25
- 30% co-payment for all drugs costing more than $25
- Mandatory generic, if the member elects to purchase brand, the member must pay the difference in price between generic and brand
- $7,000 annual cap total for member and spouse not including member co-payments
HIP Members
HIP members are NOT eligible for prescriptions benefits through the SOC and instead are mailed annually each March a $350 reimbursement check only if the member has purchased a prescription rider through HIP.
Prescription Cards
Upon notification of a member's retirement by the Payroll Section of NYPD, the SOC mails the member a retirement package that includes a blue membership data card. Once the member completes and returns this card to the SOC, a prescription card is ordered for the member and spouse. Please note: this may result in a break in prescription coverage. The member can file for reimbursement using the form linked above if any prescriptions are purchased during this break in coverage.
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
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. Mail-order prescriptions $100 and under require a $10 co-payment and mail-order presciptions over $100 require a 30% co-payment.
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 for those under 65 years of age and not on Medicare. Members over 65 or/and on Medicare are no longer covered under the PICA program and should use their SOC prescription benefit to fill those prescriptions. Psychotropic and Asthma medication will no longer be availabe 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.
Medicare Part D
As of January 2006, Medicare now offers a prescription plan. SOC members who regularly meet the $7,000 dollar annual cap of the prescription benefit may want to consider joining Medicare Part D to alleviate costs. If a member and/or spouse joins Medicare Part D, his or her prescription coverage will be terminated with the SOC, as no coordination of benefits is offered in the SOC prescription plan. The member is allowed to rejoin the SOC prescription plan only once.
The SOC has absolutely no control over a member's enrollment in Medicare Part D. We cannot enroll or disenroll a member from Medicare Part D.
Any questions or difficulties about Medicare Part D should be forwarded to Social Security or to Medicare.