2012 Benefit Enrollment Guide - Education Management Corporation

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Prescription Drugs
When you enroll in a medical plan, you automatically receive prescription drug benefits, which are easy
to use. If you choose to waive medical coverage, you also waive prescription drug coverage.
The prescription drug benefit, administered by Aetna, works the same way regardless of which medical
plan you choose. You must buy the medications from a pharmacy in the Aetna network or use the
mail-order service available. To find a list of participating pharmacies near you, go to www.aetna.com/docfind.
Choose “Pharmacy” under the provider category and follow the prompts.
1-866-738-6737
www.aetna.com
Here’s how much you will pay for covered prescription medications:
Generic drugs
Generic drugs are approved by the FDA and are just as effective
as their brand-name counterparts, but they cost much less.
You can save even more by getting medications you take
every day through the convenient mail-order service. You pay:
Retail:
Mail order:
30-day supply = $10 90-day supply = $20
Note: Approved smoking cessation prescriptions are covered at
the generic copayment amount.
Brand-name formulary drugs
A formulary is a list of medications that Aetna prefers to cover,
generally because they cost less than other equally effective
brand-name drugs. You can find a copy of the Aetna Preferred
Drug List (formulary) at www.aetna.com/formulary (when
prompted, select the “Three-tier Open Formulary”). You pay:
Retail:
Mail order:
30-day supply = 30% coinsurance 90-day supply = 30% coinsurance
($20 minimum / $100 maximum) ($40 minimum / $200 maximum)
Brand-name nonformulary drugs
These are brand-name medications that are not on the Aetna
Preferred Drug List (formulary). They generally cost more than
drugs on the formulary. You can talk with your doctor to see if it
is safe to switch to a medication that will cost you less. You pay:
Retail:
Mail order:
30-day supply = 30% coinsurance 90-day supply = 30% coinsurance
($35 minimum / $100 maximum) ($70 minimum / $200 maximum)
Over-the-counter Claritin ® or Prilosec
If needed, ask your doctor for a prescription for Claritin or
Prilosec, specifying “OTC” on the prescription. Give the
prescription to the pharmacist to fill and you will be charged
the applicable copay amount. If you pick up the product from
the shelf and take it to the cashier, you will be charged the
store’s retail price. You pay:
Retail: 30-day supply = $5 Mail order: not available
90-day supply = $10
A quick note about prescribed generic medications
You are responsible for the payment differential when a generic
drug is authorized by your physician and you elect to purchase a
brand-name drug. Your payment is the price difference between
the brand-name drug, and the generic drug, in addition to the
brand-name drug copayment or coinsurance amounts which
may apply.
Questions? Contact HR One Connect at 1.888.471.3362 (1.888.HR1.EDMC).
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