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MEDCO FAQs pdfDownload a PDF version of this FAQ

FREQUENTLY ASKED QUESTIONS


MEDCO

Why did MPS go to a three-tier formulary drug plan?

How will my prescription drug co-pay be determined under the new prescription drug formulary?

How frequently and by whom are changes made to the placement of brand-name drugs in the cost tiers?

What is generic?

Are generic drugs safe?

What is preferred brand-name?

What is non-preferred brand-name?

What if my doctor prescribed a non-preferred brand-name drug?

How can I find out if my brand-name drug is in coverage Tier 2 or Tier 3?

How else can I save on my prescriptions?

Are there any other benefits to using Medco Pharmacy?

What is electronic coordination of benefits (eCOB)?

Why did MPS go to a three-tier formulary drug plan? Back to top

MPS and its unions agreed to change the drug plan design to a three-tier formulary in order to obtain competitive pricing in the market and to better manage its $45+ million annual cost without sacrificing the quality of or access to prescription drug benefits.  The intent is to provide an incentive to use lower cost generics, and for those who choose to use Tier 2 preferred name-brand, the benefit continues at the same 10% employee co-pay level with the exception of a new $15 minimum co-pay feature.

How will my prescription drug co-pay be determined under the new prescription drug formulary?
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The formulary used for the MPS PPO/Indemnity Health Plan and EPO Health Plan is managed by Medco and is designed to provide three tiers of coverage with Tier 1 – Generic Drugs always being the lowest cost co-pay.
PRESCRIPTION DRUG
COVERAGE
TIERS
YOUR CO-PAY
AT PARTICIPATING
RETAIL PHARMACIES
(up to a 30-day supply)
YOUR CO-PAY
THROUGH MAIL ORDER
MEDCO PHARMACY ONLY
(up to a 90-day supply)
Tier 1:  Generic Drugs
$3 $6
Tier 2:  Preferred Brand-name 10% with a minimum $15 co-pay $30
Tier 3:  Non-Preferred Brand-name
    (not on preferred drug list)
20% with a minimum $30 co-pay $60

How frequently and by whom are changes made to the placement of brand-name drugs in the cost tiers? Back to top

The formulary is reviewed by a Pharmacy and Therapeutics Committee, an independent committee of practicing physicians and pharmacists.  The committee reviews and evaluates medications to ensure they are safe and effective.  Non-preferred drugs have an equally effective and less costly generic equivalent or may have one or more preferred brand-name drug alternatives available.  As new drugs come on the market, changes occur to their placement on the cost tiers. Changes can occur two to three times per year.

Talk to your doctor and ask whether a generic or plan-preferred drug would be right for you.  If s/he agrees, ask for a new prescription.  If your doctor believes that long-term use is necessary, ask for up to a 90-day supply, plus three refills for up to one year (if appropriate) and use the mail order service.  You can find out what coverage tier your drug(s) fall under by accessing the MPS Portal or calling Medco at 1-800-316-9178.

What is generic?
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Generic drugs are chemically identical to brand-name drugs in dosage form, safety, strength, and quality but cost 30 to 80 percent less.

Are generic drugs safe?
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Yes.  Generic drugs, like brand-name drugs, must meet established FDA standards of quality and purity to help ensure their safety and effectiveness, and they usually cost less.  Generic versions have the exact same active ingredients as their brand-name counterparts and are equal in strength and dosage.  Sometimes drug manufacturers use different active ingredients, such as fillers and dyes, which provide a drug’s shape, color, size and taste.

What is preferred brand-name?
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Preferred brand-name drugs are preferred by the formulary used by the health plan because they are safe, effective alternatives to other brand medications that are generally more expensive.

What is non-preferred brand-name?
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Non-preferred drugs have an equally effective and less costly generic equivalent or may have one or more preferred brand-name drug alternatives available; they have a higher co-payment than preferred drugs.

What if my doctor prescribed a non-preferred brand-name drug?
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You can ask your doctor to consider prescribing a preferred or generic drug that will cost less but will be equally as effective.  Only your doctor can change your prescription.

How can I find out if my brand-name drug is in coverage Tier 2 or Tier 3?
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How else can I save on my prescriptions?
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You could save by using the Medco Pharmacy mail order service.  With Medco Pharmacy, you will pay just one co-payment for up to a 90-day supply.  Just ask your doctor for a new prescription for up to a 90-day supply, plus refills for up to one year (as appropriate).  Make sure you have a two-week supply on hand.  If not, ask your doctor for a 14-day prescription that you can fill at a participating pharmacy so that you have medication on hand while you wait for your mail-order prescription to arrive.  Either mail your prescription to the Medco mail order pharmacy or ask your doctor to fax it to Medco.  You will usually receive your medication within eight days after Medco receives your order.

Are there any other benefits to using Medco Pharmacy?
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Another advantage of the Medco Pharmacy is the full support of Medco specialist pharmacists who are specially trained in the medications that treat an ongoing condition, such as asthma, heart disease, or diabetes.  Specialist pharmacists are available when you need them, 24 hours a day, 7 days a week.  They can work with you and your doctor to help make sure that your medications work safely together and work well for you.


What is electronic Coordination of Benefits (eCOB)?
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If the MPS plan is secondary coverage for prescription drugs because you or any of your covered dependents also have other insurance covering prescription drugs, coordination of benefits is now available electronically at participating retail pharmacies.  To take advantage of eCOB, you must use a participating retail pharmacy set up for electronic claims submission.  Please note that if a pharmacy is not equipped to submit electronic COB claims, or if you use a non-participating pharmacy, you must continue to submit paper claims to Medco for reimbursement of your covered out-of-pocket expenses.

Important:  Update MPS with changes to your other insurance coverage for prescription drugs, at any time throughout the year, for you or your covered dependents under an MPS plan.  You may contact the MPS Benefits and Insurance Services Division at (414) 475-8217.