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.