PICA

New Annual Deductible for Injectable & Chemotherapy Medications

Effective January 1, 2006, there will be an annual deductible of $100 per person for Injectable & Chemotherapy medications. This deductible is independent of any other deductibles.

Additional changes that have already taken effect:

Effective July 1, 2005, the PICA Prescription Drug Program will only cover two (2) categories of drugs: Injectables and Chemotherapy.

New Co-payments for Injectable & Chemotherapy Medications

Retail Pharmacy (up to 30-day supply)

  • $10 for generic medications
  • $25 for preferred brand name (formulary) medications
  • $45 for non-preferred brand name (non-formulary) medications*

Mail Order Pharmacy (up to 90-day supply)

  • $20 for generic medications
  • $50 for preferred brand name (formulary) medications
  • $90 for non-preferred brand name (non-formulary) medications*

*If you choose a non-preferred brand name medication that has a generic equivalent, you will be charged the difference in cost between the non-preferred brand name drug and the generic drug plus the non-preferred co-pay.

Effective July 1, 2005, Coverage for Psychotropic and Asthma medications returned to the PBA Funds Office through Caremark. If you have a prescription refill with NPA/Express for either a Psychotropic or Asthma medication, you will need a new prescription after July 1, 2005 to file with Caremark. Your Caremark coverage does not require mandatory mail order for either Psychotropic or Asthma medications.

ACTIVE MEMBERS:

Please note, both Psychotropic and Asthma medications will be subject to the standard Caremark co-payments as follows:

  • $5 for generic medications
  • $5 for formulary medications
  • $8 for non-formulary medications

RETIRED MEMBERS (Non Medicare):

Please note, both Psychotropic and Asthma medications will be subject to the standard Caremark co-payments as follows:

  • Generic – Greater of $20.00 or 25% of Caremark's discounted drug cost*
  • Formulary – Greater of $40.00 or 25% of Caremark's discounted drug cost*
  • Non-Formulary – 100% of Caremark's discounted drug cost*

*Co-payments will not exceed Caremark's discounted drug cost.

If you have any questions regarding your PICA prescriptions, please contact NPA/Express Scripts Customer Service at (800) 467-2006. For questions regarding your Caremark prescriptions, please contact the PBA Funds Office at (212) 349-7560 or Caremark Customer Service at (877) 722-7911.