Prescription highlights

Prescription highlight reel

Everyone talks about the importance of prescriptions and their high cost. All eight of the city’s health-plan choices provide seamless coverage over that gap. All plans offer benefits much more generous than Medicare Part D. The Medicare supplement plan F provides a companion drug plan that offers benefits that are equal to the other plans.

You enjoy one of the richest prescription benefits around – fixed copayments for most covered prescriptions. Those benefits are costly. We expect to spend more than $55 million in prescriptions in 2010. That’s more than 19 percent of the total health-plan cost. Half of that cost is for retiree prescriptions.

We know how important prescription coverage is when you’re choosing a plan. Below are prescription-coverage costs for all nine city health plans. Use this chart and the list of prescriptions on page 24, or each plan’s formulary list, when you’re estimating your annual cost for health care on Sheet B, inserted. That will help you determine which plan is best for you.

What is a formulary

A formulary is a list of covered drugs. Each plan’s formulary is different and can change each year. The drug formulary established by Medicare for 2010 serves as the model for Medicare Advantage formularies. View the 2010 formularies at these Web sites:

Formularies may change each January and May.

Because the other benefits are similar, many retirees make their decisions based on what tier their prescriptions fall in the formulary. Now that we offer nine choices, you should pay close attention to the copayments for your prescriptions. The top ten retiree prescriptions are listed below.

Use the prescription copayment worksheet provided in your packet to list out each of your prescriptions and the copayments for each of the plans. This can help you make an informed decision and eliminate any surprises.

Prescription copayments at a particpating pharmacy

Prescription copayments at a participating pharmacy

Generic

Preferred brand

Non-preferred

Specialty

drugs

Medicare

Part B

30-day/ 31-day supply

90-day supply

30-day/ 31-day supply

90-day supply

30-day/ 31-day supply

90-day supply

30-day/ 31-day supply

90-day supply

HMO

KelseyCare Advantage HMO

$10

$20

$30

$60

$45

$90

$45

N/A

15% up to $1,500

TexanPlus

$10

$20*

$30

$60*

$45

$90*

$45

$90*

20% up to $1,500

Texas HealthSpring

$10

$20

$30

$60

N/A

N/A

$45**

$90**

15% up to $1,000

BCBS HMO

$10

$20

$30

$60

$45

$90

$45***

N/A

Same as

non-preferred

PPO and POS

Aetna PPO

$10

$20

$30

$60

$45

$90

$45

$90

$0

KelseyCare Advantage Plus Choice POS

$10

$20

$30

$60

$45

$90

$45

N/A

15% up to $1,500

BCBS PPO

$10

$20

$30

$60

$45

$90

$45***

N/A

Same as

non-preferred

Network-free

Aetna PFFS

$10

$20

$30

$60

$45

$90

$45

$90

$0

Medicare Supplement Plan F companion drug plan

$10

$20

$30

$60

$45

$90

$45**

$90**

$0

*TexanPlus does not have a mail-order option. You can fill a 90-day prescription for a two-month copayment at your local network pharmacy,
** Prior authorization is required.
*** Specialty prescription drugs must be obtained through the Triessent Specialty Drug Program.

Top 10 retiree prescriptions by amount spent

Top 10 retiree prescriptions by amount spent

Drug
Treatment

What you pay

BCBS pays

Aetna PPO and PFFS

KelseyCare Advantage HMO and PPO

UHC Medicare Supplement companion drug plan

TexanPlus

Texas

HealthSpring

BCBS HMO and PPO

1

Lipitor
Cholesterol

$30

$45

$30

$30

$30

$45

$102

2

Nexium
GERD

$30

$45

$30

$30

$30

$30

$165

3

Actos
Diabetes

$30

$30

$30

$45

$30

$30

$184

4

Enbrel
Rheumatoid Arthritis

$30*

$45*

$45*

$45*

$45*

$30*

$2,088

5

Prevacid
GERD

not covered

$30

$45

not covered

$45

$45

$152

6

Tracleer
Primary Pulmonary hypertension

$45

$45*

$45*

$45*

$45*

$30*

$3,626

7

Lotrel
High Blood Pressure

$45

$30

$45

$30

$30

$30

$88

8

Avandia
Diabetes

$30

$30

$30

not covered

$30

$30

$155

9

Simvastatin
Cholesterol

$10

$10

$10

$10

$10

$10

$84

10

Diovan
High Blood Pressure

$30

$30

$30

$30

$30

$30*

$54

* Some prescriptions, such as Enbrel and Tracleer, are considered specialty drugs and require prior authorization from the plan. For the BCBS HMO and PPO, these drugs must be ordered through the Triessent Specialty Drug Program. Call 888-216-6710 to sign up.

  
 
 
 
 
 

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