Community
Blue Members to Pay More for Prescriptions
Members
enrolled in Community Blue will have
to pay significantly more for their prescriptions beginning in January 2003. A
comparison of the current copay amounts to the new copay amounts is indicated
below:
|
|
2002
Benefit |
2003
Benefit |
|
|
Prescription
Drugs |
$5
generic for up to a 30-day supply. If a generic drug is available and a
brand name drug is dispensed, the member pays the copayment plus the
difference between the cost of the generic drug and brand name drug. A
select list of maintenance prescriptions may be purchased in a 100 unit
supply for a $5.00 copay, subject to prior approval. |
30-day
supply
|
$5
generic $15
formulary $35 non-formulary |
| 90-day supply, mail order |
$15
generic $45
formulary $105 non-formulary |
||
| Cough and cold products are limited to a 10-day supply. Antibiotics are also limited to a 10-day supply with one refill. Certain drugs are subject to pre-approval to be eligible for coverage under the benefit. | |||
Community
Blue has advised us that a letter, dated
Members
may want to know why Community Blue was allowed to make this change. PEF does
not negotiate the level of benefits provided by the HMOs. Therefore, HMOs may
change their benefits from one year to the next, and often do make such changes.
PEF, along with the other state employee unions, has negotiated the right to
participate in the process used by the NYS Department of Civil Service to select
the HMOs that will be offered to state employees. Through this joint
labor-management process, a minimum level of benefits is established. For
example, HMOs participating in NYSHIP must provide prescription drug coverage
with no deductible, or annual and lifetime maximums. The copay amounts, however,
are determined solely by the HMO.
For
more information regarding the decision to increase the prescription drug copay
amounts, members should call the nearest Community Blue Member Services Office: