|
Summary
of your Screen Actors Guild-Producers Health Plan
Prescription Drug Plan
Effective January 1, 2003
|
|
Prescription
Drug Plan
Effective January 1, 2003
|
Retail
Network Pharmacy
|
Medco
Home Delivery Pharmacy ServiceTM
(formerly referred to as mail service)
|
| Days
Supply |
Up
to 30 days
per prescription and/or refill
|
Up
to 90 days
per prescription and/or refill
|
Deductible
(per calendar year)
Applies to drugs purchased at both a retail network
pharmacy and through the Medco Home Delivery
Pharmacy Service. |
$100
individual / $200 family¹
|
$100
individual / $200 family¹
|
| Generic
drugs |
$10
or 20% of the prescription drug's total cost,
whichever is greater
|
$10
or 15% of the prescription drug's total cost,
whichever is greater;
maximum co-payment is $75 per prescription
|
| Brand-name
drug |
$20
or 25% of the prescription drug's total cost,
whichever is greater
|
$20
or 20% of the prescription drug's total cost,
whichever is greater;
maximum co-payment is $75 per prescription
|
Multi-Source
brand-name drug
(Generic equivalent is available)
Applicable with or without DAW (dispense as written)
indication on prescription. |
$20
or 25% of the prescription drug's total cost, whichever
is greater, PLUS the difference in cost between
brand and generic²
Example:
-
$55 total cost of brand-name drug
- $30
total cost of generic drug
- $20
total co-payment of brand-name drug
| Assuming
your deductible is satisfied, you pay: |
| brand-name co-payment
|
$20 |
| brand/generic cost difference
|
+$25 |
| |
|
| your total payment |
$45 |
|
$20
or 20% of the prescription drug's total cost, whichever
is greater, PLUS the difference in cost between
brand and generic²
;
the maximum co-payment is $75 per prescription
Example:
- $120
total cost of brand-name drug
- $70
total cost of generic drug
- $24
total co-payment of brand-name drug (20% of
$120)
| Assuming
your deductible is satisfied, you pay: |
| brand-name co-payment
|
$24 |
| brand/generic cost difference
|
+$50 |
| |
|
| your total payment |
$74 |
|
|
|
|
