| Select
Drug Program ® $10/$20/$35 with Oral Contraceptives |
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You receive coverage for medically necessary prescription drugs*, including oral contraceptives, under this additional benefit when the drugs are prescribed by a licensed, practicing physician.
Your Select Drug Program uses an incentive formulary, which is a defined list of selected drugs that have been evaluated for their medical effectiveness, positive results and value.
> When you purchase drugs from our Select Drug Program Formulary, a $10 copayment
is required for each generic prescription and a $20 copayment is required for each brand
name prescription.> If you choose covered drugs not listed on the Select Drug Program Formulary, you are
responsible for a $35 copayment.> You may receive up to a 30-day supply of your medication at the pharmacy.
In addition, covered medications for chronic conditions (such as blood pressure medications) may be provided through our convenient mail order service for up to a 90-day supply. You will pay two times the brand or generic copayment for a formulary drug or two times the non-formulary copayment for covered non-formulary drugs. This benefit saves you time and money.
To qualify as a covered benefit and ensure that the drug prescribed is medically appropriate, certain drugs require prior authorization. As a member, your physician can initiate prior authorization for these medications if they are medically appropriate. You have the right to appeal any decision through the Complaints and Grievance Process.
As a member you may visit any participating pharmacy to fill your prescription needs. The Select Drug Program gives you access to thousands of pharmacies nationwide through PAID prescriptions' network. Covered prescription drugs purchased at a non-participating retail pharmacy will be reimbursed at 30% of the drug's cost.
* This summary is intended to highlight the benefits available to you. For a complete plan description, including all benefits and exclusions, refer to your benefit booklet or group contract. Examples of some items not covered include: All injectable medications (except those listed on the formulary); weight control drugs; experimental drugs; drugs & supplies that can be purchased over the counter; drugs used for cosmetic purposes (e.g. anabolic steroids and minoxidil lotion, Retin-A for aging skin); and nicotine gum or patches for smoking cessation.
