Settlement Summary Prescription Copayments

Note that the changes in the prescription copayment tiers negotiated to take effect on July 1, 2017, will not take effect until January 1, 2018. As a result, the current copayment amounts will continue for an additional six months.

FY2017 Current F/T Active Prescription Tiers
  • Generic: $5
  • Preferred brand name: $15
  • Non-preferred brand name: $25
  • Copayments for specialty drugs are charged at the non-preferred brand name rate.
Tentative F/T Active Prescription Tiers
 1/1/181/1/191/1/20
Generic$5$5$5
Preferred Brand$20$20$20
Non-Preferred Brand$35$35$35
Specialty*$50**$65**$75**

Once ratified, the proposed tier structure remains in place and may not be altered until 1/1/21. (*) For the purposes of this provision, specialty drugs are defined as only those specialty drugs that are injectable until 1/1/2019, at which time the definition specialty drug may expand. Insulin may not be considered a specialty drug under either pre- or post-2019 definitions.

(**) The dollar amounts listed as copays for specialty drugs are subject to maximums allowable. The actual amount due from the employee shall be either the dollar amount listed or 50% of the actual cost at the counter, whichever is less.