Prescription Drug Coverage

Effective April 1, 2020, all new prescriptions will use the standard formulary. POS Advantage members currently using brand drugs will be allowed to continue using them until no longer prescribed without interruption even if the member elects a new medical plan during the Special Open Enrollment. If you take medications on a regular basis, you know how expensive medicines can be. One of the easiest ways to keep prescription drug expense down is to choose generic medications over brand name drugs whenever possible.

Continued use of brand name drugs will be subject to any cost differential between generic and brand name, plus applicable copayments. Maintenance medications can be filled at a retail pharmacy up to a maximum of three times. Subsequent refills are required to be filled via CVS Mail Order or Maintenance Choice limited retail pharmacy network (CVS Mail Order, CVS, Target & Navarro pharmacies). Existing prescriptions will be honored and can be transferred. 

Generic Drugs First
Your prescription drug plan is designed to save you money. Before you use a brand-name drugs, you will first need to try a similar, alternative medication. In most cases, this will be a generic drug. Generics are approved by the Federal Drug Administration (FDA) as safe and effective but will cost you less. Effective April 1, 2020, POS plan employees and dependents will be subject to use generics first. All new prescriptions will use the standard formulary and brand name prescriptions will be subject to any cost differential between generic and brand name, plus applicable copays as they are today in the HMO plans.

Example: Before you can fill a new prescription for the brand-name drug Crestor, you will need to try one of the generic alternatives first – atorvastatin, fluvastatin, lovastatin, pravastatin or simvastatin. The list of prescription drugs, both generic and brand name, covered by the Plan have been updated with newly approved drugs that are more cost effective. Rarely used and/or outdated drugs have been removed.

Advantage POS Members
Advantage POS members currently using brand name prescription drugs will be allowed to continue use without interruption until no longer prescribed.  All new prescriptions will use the standard formulary and brand name prescriptions will be subject to any cost differential between generic and brand name, plus applicable copays as they are today in the HMO plans. 

Changes to Maintenance Medication (90-day) Prescription Drug Pharmacy Network
For a 90-day supply from a mail/maintenance choice pharmacy, members pay only two copays instead of three copays saving members one copay. Maintenance drugs would be filled at retail pharmacy three times and subsequent refills would be filled using the Maintenance Choice options.

Maintenance medication prescriptions will be subject to Maintenance Choice options; mail order pharmacy or can be obtained through a Limited Network Pharmacy (CVS, Target and Navarro). After three refills at a retail pharmacy you will no longer be approved to fill a maintenance medication prescription. Out-of-network pharmacy users do not receive any discounts from the plan and are no longer covered under the Plan for filling maintenance medication prescriptions unless using a Maintenance Choice option.