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ACTIVE FUND
Prescription Drug Plan

 

The PBA Health and Welfare Fund Prescription Drug Plan, administered by CVS Caremark, covers most FDA approved prescription drugs.

 Prescription Drug Copayments (Retail and Mail)
 Generic $5
 Preferred Brand $5
 Non-Preferred Brand $8

Prescription drug copayments apply to accumulated annual Plan benefits of up to $50,000 per family. After the Plan has paid $50,000, coinsurance of 50% will apply. Plan benefits are accumulated every September 1 through August 31.

Retail and Mail Order Prescriptions
Most prescriptions can be filled for up to a 30-day supply at participating retail pharmacy locations nation-wide. Prescriptions for maintenance medications, which are medications expected to be taken for extended periods of time, must be filled at a CVS Pharmacy or through CVS Caremark’s Mail Order Pharmacy for up to a 90-day supply.

Generic Step Therapy
For some classes of drugs, you may have to try one or more generic alternatives before a brand drug can be covered. For a list of such classes of drugs, please contact Caremark at (877) 722-7911.

Medications Covered by other Plans
Some medications are excluded because they are covered by other health plans through the City of New York.

Examples include:

  • Your health insurance carrier through the City of New York Health Benefits Program covers:
    • Diabetes medications and supplies
    • Contraceptives and preventive medications (GHI-CBP and HIIP HMO only)
    • Substance use disorder medications
  • The NYC PICA Program covers self-injectible and chemotherapy medications.

Medical Division's Line-of-Duty Prescription Drug Unit covers Prescriptions related to an approved line-of-duty injury.