a PDF version of this FAQ
FREQUENTLY ASKED QUESTIONS
did MPS go to a
three-tier formulary drug
How will my
co-pay be determined
under the new prescription drug formulary?
frequently and by
whom are changes made to
the placement of brand-name drugs in the cost tiers?
if my doctor
prescribed a non-preferred
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
benefits to using Medco
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? Back to top
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.
frequently and by whom are changes made to the placement of brand-name
drugs in the cost tiers? Back to top
(up to a 30-day supply)
THROUGH MAIL ORDER
MEDCO PHARMACY ONLY
(up to a 90-day supply)
|Tier 1: Generic Drugs
|Tier 2: Preferred
with a minimum $15 co-pay
|Tier 3: Non-Preferred
(not on preferred drug list)
|20% with a minimum $30
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?
Back to top
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? Back to top
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.
preferred brand-name? Back to top
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.
non-preferred brand-name? Back to top
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? Back to top
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
How can I find
out if my brand-name drug is in coverage Tier 2 or Tier 3? Back to top
How else can I save
on my prescriptions? Back to top
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
Are there any
other benefits to using Medco Pharmacy? Back to top
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)? Back
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.
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.