As an employee enrolled in one of the State’s health care plans, as provided by Aetna or Blue Cross Blue Shield of Delaware, you will be automatically enrolled in the prescription drug plan managed by Medco Health Solutions, Inc. (Medco). Your Benefit Representative may provide you with more information to accommodate your needs. The State of Delaware, in partnership with Medco, has designed and implemented a comprehensive prescription drug program to provide you with the medications required in a cost-effective and efficient manner. Co-pays are designed to reflect the amount of medication received, a 30-day or 90-day supply, and if the medication is generic, preferred, or non-preferred. Additional information on this benefit program may be reviewed at http://ben.omb.delaware.gov/script/index.shtml
Maintenance Medication Program Effective July 1, 2009, members are required to have maintenance medications filled as 90 day fills after receiving three 30 day fills. Prescriptions may be filled at either a 90 day participating pharmacy or Medco-by-Mail. Members may have their treating physician write a 30 day prescription and a 90 day prescription and have the 30 day prescription filled first to ensure its effectiveness and then have the 90 day prescription filled. The penalty, described below, does not occur until the 30 day prescription is filled the fourth time. The Maintenance Medication Program provides cost savings to members and the State of Delaware. A maintenance medication is a medication that generally is used to control a condition or disease that lasts for an extended period of time (up to a lifetime). These medications do not cure a condition or disease but do control it and without taking maintenance medications the member’s quality of life would suffer. A few examples of these conditions and diseases include diabetes, high blood pressure (hypertension), cholesterol, and asthma. Members should discuss their condition or disease with their treating physician to determine if a maintenance medication is appropriate. Non-maintenance medications are those medications used to treat short term conditions. In general these medications will cure or help cure a disease or condition. These medications are taken for a short period of time and when the disease or condition is cured there is no need to continue taking the medication. A few examples of these conditions and diseases include bronchitis, ear infections, sinus infections, and bone or muscle injuries. When members receive maintenance medications every 30 days, they pay three 30 day copays in order to receive a 90 day supply of medication. Members can realize a savings by having 90 day prescriptions filled, for example.
Beginning July 1, 2009, if a member does not choose to fill a maintenance medication for a 90 day supply after filling the medication for three 30 day supplies, a penalty will be assessed and the member will pay a copay equivalent to the applicable 90 day copay for the medication. For example:
Members may have 90 day prescriptions filled at a 90 day participating pharmacy or Medco-by Mail. A list of 90 day participating pharmacies, within and outside of Delaware, is located at http://ben.omb.delaware.gov/script/index.shtml or by calling Medco’s Member Services at 1-800-939-2142. Prescriptions written for 90 day fills may be filled by either of these methods:
New members will receive notice of this program when they join the State of Delaware’s health care plan and receive reminder letters as 30 day prescriptions are filled warning of the penalty at the fourth fill. Sample letters are available at http://ben.omb.delaware.gov/script/index.shtml. Medications, such as certain controlled substances or medications that are pre-packaged, are not available in a 90-day supply and any current quantity or plan limits remain in effect. Concerns and questions may be directed to Medco’s Member Services at 1-800-939-2142 or Statewide Benefits Office at 302-739-8331 or 1-800-489-8933. |
