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$0 Generic Copay Program (Retirees)
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Beginning July 1, 2021, Retirees under 65 enrolled in the PSC-CUNY Welfare Fund Prescription Plan, as well as Retirees enrolled in the SilverScript Medicare Part D Prescription Plan will have no copay when filling a prescription for a generic drug included in the PSC-CUNY Welfare Fund Drug List (under 65) or the SilverScript Formulary (for Medicare-eligible retirees) 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 Welfare Fund Drug List or the SilverScript 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 Welfare Fund Drug List or the SilverScript Formulary at a retail pharmacy other than CVS will not have a reduced copay. This means most members using non-CVS pharmacies will continue to pay a 20% copay.
Retirees Under 65
Member copays for generic drugs on the Welfare Fund Drug List purchased at non-CVS pharmacies are 20% 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 for generics purchased at non-CVS pharmacies 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 copay for generics purchased at non-CVS pharmacies 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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