Settlement Summary Prescription Copayments

Apr 04, 2017

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

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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.

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