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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.