The Medcohealth Prescription Drug Card Plan is available for all members enrolled in a health plan under the NYCHBP. Enrollment under this plan is automatic once you have completed and filed a PSC-CUNY Data Sheet.
Members who choose Aetna HMO, Aetna QPOS, CIGNA Healthcare, HIP Prime POS, or GHI HMO as their primary health carrier and decide to purchase the health benefit drug rider through payroll deductions, will be eligible for an annual stipend from the PSC-CUNY Welfare Fund of $300 for individual and $700 for family coverage. If you only pay for the rider for part of a year, your reimbursement, which is typically processed in January, will be pro-rated accordingly.
The Prescription Drug Plan has an annual cap of $10,000 per individual.
The plan covers most drugs that legally require a prescription and have FDA approval for treatment of the specified condition, including psychotropic and asthma drugs. The plan does not cover drugs, which are available without a prescription or are "over the counter" (OTC).
The first two times you use your local pharmacy for a new prescription, your co-pay for a 30-day supply is: $5 for generic drugs, $15 for preferred brand name drugs, $30 for non-preferred brand name drugs, or 20% coinsurance, whichever is greater.
If the retail cost of the drug is less than the minimum co-payment, you only pay the retail cost.
If you wish to continue to use your local pharmacy for maintenance medication after the second fill, the co-payments are as follows: $5 for generic drugs, $15 for preferred brand name drugs, $30 for non-preferred brand name drugs, or 35% coinsurance, whichever is greater.
You must pay the full cost of the prescription if you fill your retail prescription at a nonparticipating pharmacy. Complete a direct reimbursement claim form, and submit it to Medco Health. Medco will reimburse you the cost of the medication minus the coinsurance you would have paid. You can order claim forms online at Medco Health.
For a 100-day (three-month) supply your co-pay is: $5 for generic drugs, $30 for preferred brand name drugs, $60 for non-preferred brand name drugs, or 20% coinsurance, whichever is greater. Standard shipping and handling is free.