Prescription Drug Coverage For PML Employees
Your prescription drug benefit depends on the medical plan you select and are
summarized below. Each plan has limitations and exclusions. It is suggested that you
consult your benefit booklets or contact your carrier for specifics about your plan.
Employee Health Insurance Management, Inc. (EHIM) Covered Plans:
BCBSM PPO Plans 1 and 4
| Generic Drugs |
Covered - $5 Co-pay |
| Brand Name Drugs when no generic equivalent is available |
Covered - $15 Co-pay |
| Brand Name Drugs when generic equivalent is available |
Covered - Difference between brand name drug and generic drug plus $15 Co-pay |
| Brand Name Drugs if generic is available, if *DAW is written |
Covered - $15 Co-pay |
| Designer Drugs for specific medications |
Covered - 50% |
*DAW - "Dispense as Written"; A notation by the physician that the specific drug on the prescription is to be dispensed without substitution of any other drug.
A Word About Generic Drugs:Generic drugs have the same active ingredients, strength and
dosage as their brand-name counterparts. The primary difference is that they cost a whole lot
less! Pharmacies will automatically dispense generic equivalent drugs unless your physician
writes "Dispense As Written" (DAW) on the prescription. You will pay $10 for a one month (34-
day) supply. Generic drugs cost less because they don’t require the same costly research,
development and sales expenses associated with brand name drugs.
What is the difference between generic and brand-name drugs?:
The brand-name drug is the name under which the product is originally sold. A
brand-name is protected by a patent for up to 17 years. When the patent
expires, other manufacturers can produce the generic equivalent of the brand
and sell it under its generic, or chemical name.
Generic drugs are made with the same active ingredients and are available in the
same strength and dosage form as equivalent brand-name products. The
difference is in the name, and in the price.
Ask your physician or pharmacist if any of the prescription medications you are currently taking
can be filled with a generic alternative. By using generic drugs, you can reduce your
prescription drug costs while maintaining the same strength, dosage and quality as the brand name
drug. Exclusions: Your Prescription Drug Vendor WILL NOT CoverDrugs that cost the same or less than your co-payment, drugs for cosmetic purposes, lifestyle
drugs, infertility medications, more than a 34 day supply, except for specified maintenance
drugs, refills not authorized by a physician or dispensed after one year from the date of the
order, and therapeutic devices/appliances such as bedpans or elastic bandages. |
