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Prescription highlights

Prescription highlight reel

Everyone talks about the importance of prescriptions and their high cost. All nine of the city’s health-plan choices provide seamless coverage through the gap. All plans offer benefits much more generous than Medicare Part D. The Medicare supplement plan F provides a companion drug plan that offers benefits equal to the other plans.

You enjoy one of the richest prescription benefits around – fixed copayments for most covered prescriptions. Those benefits are costly. We expect to spend more than $43 million in prescriptions in 2010. That’s more than 17 percent of the total health-plan cost. Half of that cost is for retiree prescriptions.

We know how important prescription coverage is when you’re choosing a plan. Below are prescription-coverage costs for all nine city health plans. Use this chart and the list of prescriptions provided, or each plan’s formulary list, when you’re estimating your annual cost for health care. Use the worksheets on the back of each comparison chart to help you determine which plan is best for you.

The BCBSTX HMO and PPO brand-name prescription copayments are increasing, effective May 1. The increased copayments are shown in bold red.

Prescription copayments at a participating pharmacy
  Generic Preferred brand Non-preferred Specialty
drugs		 Medicare
Part B
30-day/ 31-day supply 90-day supply 30-day/ 31-day supply 90-day supply 30-day/ 31-day supply 90-day supply 30-day/ 31-day supply 90-day supply  
HMO KelseyCare Advantage HMO $10 $20 $30 $60

$45

$90

$45

N/A

15% up to $1,500

TexanPlus HMO $10 $20* $30 $60* $45 $90* $45 $90* 20% up to $1,500
Texas HealthSpring $10 $20 $30 $60 N/A N/A $45** $90** 15% up to $1,000
BCBSTX HMO $10 $20 $35 $70 $50 $100 $35/
$50
***		 N/A Same as
non-preferred
PPO
and
POS		 Aetna PPO $10 $20 $30 $60 $45 $90 $45 $90 15%
KelseyCare Advantage Plus Choice POS $10 $20 $30 $60 $45 $90 $45 N/A 15% up to $1,500
BCBSTX PPO $10 $20 $35 $70 $50 $100 $35
-$50
***		 N/A Same as
non-preferred
Network
-free		 Aetna PFFS
 $10 $20 $30 $60 $45 $90 $45 $90* $0
Medicare supplement plan F companion drug plan $10 $20 $30 $60 $45 $90 $45** $90** $0

* TexanPlus HMO does not have a mail-order option. You can fill a 90-day prescription for a two-month copayment at your local network pharmacy,
** Prior authorization is required.
*** Specialty-prescription drugs must be obtained through the Triessent Specialty Drug Program.

Prescription highlight reel

What is a formulary?
A formulary is a list of covered drugs. Each plan’s formulary is different and can change each year. The drug formulary established by Medicare for 2010 serves as the model for Medicare plan formularies. View the 2010 formularies at these six Web sites:

Formularies may change each January and May.

Because the other benefits are similar, many retirees make their decisions based on what tier their prescriptions fall in the formulary. Now that we offer nine choices, you should pay close attention to the copayments for your prescriptions. The top ten retiree prescriptions are listed below.

Use the prescription copayment worksheet provided in your packet to list each of your prescriptions and the copayments for each of the plans. This can help you make an informed decision and eliminate surprises.

Top 10 retiree prescriptions by amount spent
Drug
Treatment		 What you pay Plan pays
Aetna PPO and PFFS KelseyCare Advantage HMO and POS UHC Medicare supplement companion drug plan TexanPlus HMO Texas
HealthSpring		 BCBSTX HMO and PPO
1 Plavix
Cholesterol		 $45 $30 $30 $30 $30 $35 $206
2 Lipitor
Cholesterol		 $30 $45 $30 $30 $30 $50* $180
3 Flomax
Alpha-blocker		 $30 $30 $30 $30 $30 $35 $167
4 Actos
Diabetes		 $30 $30 $30 $30 $30 $35 $304
5 Diovan
High Blood Pressure		 $30 $30 $30 $30 $30 $35 $118
6 Advair
Asthma		 $30 $30 $30 $30 $30 $35 $252
7 Tricor
Cholesterol 		$45 $45 $30 $30 $30 $35* $181
8 Nexium
GERD		 $30 $45 $30 $30 $30 $35* $280
9 Vytorin
Cholesterol		 $30 $45 $45 not covered $30 $50* $157
10 Actonel
Osteoporosis		 $30 $30 $30 not covered $30 $35 $149

* Step therapy drug.
Some prescriptions such as Enbrel and Tracleer, are considered specialty drugs and require prior authorization from BCBSTX and must be ordered through the Triessent Specialty Drug Program. Call 888-216-6710 to sign up for the Triessent Specialty Drug Program.

 

 

  
 
 
 
 
 

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If there exists a conflict between this Enrollment Guide Website and the official plan documents for each plan, the official plan documents will prevail. The city of Houston reserves the right to change, modify, increase or terminate any benefits.