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Article / Update to Pharmacy Benefits January 1

Update to Pharmacy Benefits January 1.

The Board of Trustees approved a few changes to the Health and Welfare Plan that will impact you when you use your pharmacy benefit January 1.

Pharmacy Benefit Changes
The first impact to members is the new minimum copayment* when a prescription is filled (max coinsurance remains the same). In addition, the Pharmacy Annual Maximum out-of-pocket has increased. These changes were approved to the Retail, Retail 90 and Mail Order Pharmacy Benefits as shown in the chart below.

Member Coinsurance effective January 1, 2017

Retail -
up to a 30-day supply purchased at retail pharmacy
Platinum PlanGold Plan
Generic10% / $10 min / $50 max20% / $10 min / $50 max
Preferred brand name35% / $20 min / $75 max35% / $20 min / $75 max
Non-preferred brand name40% / $20 min / $125 max40% / $20 min / $125 max
Diabetes & insulin supplies10% / $10 min / $50 max20% / $10 min / $50 max

Mail Order - up to 90-day supply filled through Express Scripts Home Delivery
Platinum PlanGold Plan
Generic10% / $20 min / $100 max20% / $20 min / $100 max
Preferred brand name35% / $40 min / $150 max35% / $40 min / $150 max
Non-preferred brand name40% / $40 min / $250 max40% / $40 min / $250 max
Diabetes & insulin supplies10% / $20 min / $100 max20% / $20 min / $100 max

Retail 90 - up to 90-day supply filled at a Retail Pharmacy
Platinum PlanGold Plan
Generic10% / $20 min / $125 max20% / $20 min / $125 max
Preferred brand name35% / $40 min / $200 max35% / $40 min / $200 max
Non-preferred brand name40% / $40 min / $350 max40% / $40 min / $350 max
Diabetes & insulin supplies10% / $20 min / $125 max20% / $20 min / $125 max

Specialty Medications
Platinum PlanGold Plan
Generic35% / $40 min / $150 max35% / $40 min / $150 max
Preferred brand name40% / $40 min / $250 max40% / $40 min / $250 max

Annual Maximum - Platinum & Gold Plans
Individual$3,000
Family$6,600


*Minimum copayment is a new Plan pharmacy benefit term. A minimum copayment works as follows:
You will pay UP TO the minimum copayment in addition to your coinsurance amount when filling a prescription. The minimum copayment is the minimum amount you will pay if your prescription cost exceeds the minimum copayment.