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$0 Generic Copay Program and 10% Generic Copay Program (Adjuncts)
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Beginning January 1, 2020, Active members (Full-time and Adjunct) and Retirees under 65 enrolled in the PSC-CUNY Welfare Fund Prescription Plan will have no copay when filling a prescription for a generic drug included in the Welfare Fund’s CVS $0 Generic Copay Formulary and when the prescription is filled at a CVS pharmacy or through the CVS Mail program. Generic drugs purchased outside of a CVS pharmacy are not included in the program.
How does the $0 Generic Copay Program work?
Here are examples of prescription fills to clarify the service eligible for the benefit:
Example: A member who fills a prescription for a generic drug listed on the $0 generic copay formulary at CVS or CVS mail facility would not pay a copay.
Example: A member who fills a prescription for a generic drug listed on the $0 generic copay formulary at a retail pharmacy other than CVS will not have a reduced copay, and the claim will be processed according to the Welfare Fund Prescription Plan’s current tiered copay schedule. This means most members using non-CVS pharmacies will continue to pay a 20% copay.
Members should be aware that the $0 generic copay formulary list may not include the medications they are taking, but they will be able to take advantage of the10% Generic Copay Program.
10% Generic Copay Program
Generic drugs on the Welfare Fund Drug List that are not included in the $0 Generic Copay Formulary are reduced from 20% to 10% when the prescription is filled at CVS or CVS mail until the Welfare Fund’s costs reach the Tier 1 limit (when the Fund has paid $10,000 in annual drug expenses).
When the member reaches the Tier 1 limit the copay will increase to the Tier 2 copay of 50% until the Tier 2 limit is reached (when the Fund has paid $15,000 in annual drug expenses).
At that point the member’s copay will move up to the Tier 3 copay of 80%.
Importantly, when the member reaches the Tier 1 limit they should then be eligible to apply for copay reimbursement under the new High-Cost Rx Program.
Therefore, members who anticipate their drug costs may exceed the annual Tier 1 limit ($10,000 in the Welfare Fund’s drug expenses) should SAVE ALL CVS PRESCRIPTION DRUG RECEIPTS! Receipts for all CVS prescription purchases will be required for High-Cost Rx Program reimbursement claims.
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