Benefits Enrollment & Reference Guide - Harford County Public ...

hcps.org

Benefits Enrollment & Reference Guide - Harford County Public ...

CareFirst Drug Program

Summary of Benefits

Plan Feature PPO CORE PPO Plus BlueChoice HMO Description

DEDUCTIBLE None None None Your benefit does not have a deductible.

FAMILY DEDUCTIBLE

MAXIMUM

GENERIC DRUGS (Tier 1)

(up to a 34-day supply)

PREFERRED BRAND NAME

DRUGS (Tier 2)

(up to a 34-day supply)

NON-PREFERRED BRAND

NAME DRUGS (Tier 3)

(up to a 34-day supply)

MAINTENANCE COPAYS

(up to a 90-day supply)

None None None Your benefit does not have a family

deductible maximum.

$10 $10 $5 All generic drugs are covered at this copay

level.

$25 $25 $15 All preferred brand name drugs are covered

at this copay level.

$40 $40 $35 All non-preferred brand name drugs are

covered at this copay level. If you choose

a non-preferred brand name drug (Tier 3)

instead of its generic equivalent, you will

pay the highest copay plus, the difference

in cost between the non-preferred brand

name drug and the generic.

These drugs are not on the preferred drug

list. Check the online preferred drug list to

see if there is an alternative drug available.

Discuss using alternatives with your

physician or pharmacist.

Mail Order:

generic-$10

preferred-$25

non-preferred-$40

Retail:

generic-$20

preferred-$50

non-preferred-$80

Mail Order:

generic-$20

preferred-$20

non-preferred-$20

Retail:

generic-$10

preferred-$25

non-preferred-$40

Mail Order:

generic-$10

preferred-$30

non-preferred-$70

Retail:

generic-$15

preferred-$45

non-preferred-$105

Maintenance drugs of up to a 90-day

supply are available for through Walgreens

mail order or retail pharmacy.

PRIOR AUTHORIZATION Yes Yes Yes Some prescription drugs require Prior

Authorization. Prior Authorization is a tool

used to ensure that you will achieve the

maximum clinical benefit from the use of

specific targeted drugs. Your physician or

pharmacist must call (800) 294-5979 to

begin the prior authorization process. For

the most up-to-date prior authorization

list, visit the prescription drug website at

www.carefirst.com/rx.

MANDATORY GENERIC

SUBSTITUTION

(Does not apply to Teachers

Bargaining Unit (HCEA)

members)

Yes Yes Yes If you choose a non-preferred brand

name drug (Tier 3) instead of its generic

equivalent, you will pay the highest copay

plus, the difference in cost between

the non-preferred brand name drug and

the generic. If a generic version is not

available, you will only pay the copay.

Harford County Public Schools – Benefits Enrollment & Reference Guide 25

More magazines by this user
Similar magazines