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How the Plan Works
The decisions you make about your choice in prescription drugs could have a significant impact on your total healthcare costs because the McGraw-Hill prescription benefit is based on a three-tier system. At a retail pharmacy, you will pay a percentage of the drug's actual cost (coinsurance). It works like this:
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Tier 1 includes generic drugs. In this category you pay 10% of the cost and the plan covers 90%.
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Tier 2 includes brand name drugs without generic or therapeutic alternatives and specialty drugs. Coverage is 70% and you pay 30% of the cost of the drug.
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Tier 3 includes brand-name drugs with a therapeutic or generic alternative. Coverage is 50% and you pay 50%.
To limit your total out-of-pocket expense, the maximum charge per prescription at a retail pharmacy, regardless of the tier, is $75.
A cost-saving alternative for filling your prescriptions is to use Medco's mail order program. For drugs you use on an ongoing basis, often called "maintenance drugs" (e.g., cholesterol lowering drugs, oral contraceptives, blood pressure medication, etc.), many times you can save money by purchasing them through the Medco mail order program.
When you use this service, you pay a flat-dollar copay of $20 for generic drugs and $60 for brand-name drugs for a 90-day supply of your medication vs. a one-month supply at a retail pharmacy
To find out the cost of your prescription(s), after you enroll for medical coverage visit www.medco.com. Enter your username and password, then click "Savings Advisor," which is located in the left navigation bar. Enter the name of your prescription(s) and the dosage. Medco's Savings Advisor will show you the cost of your prescription(s) at the retail pharmacy and through mail-order.
To Get the Most from Your Prescription Drug Coverage
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When your doctor writes you a prescription, ask if it's for a generic drug or a brand-name drug. If it's not a generic drug, ask if one is available. You can also ask if a therapeutic equivalent is available.
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Remember, if your prescription is only for a short course of therapy or has no refills, you only pay 10% of the cost of generic drugs at the retail pharmacy.
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For maintenance medications for chronic conditions, consider filling your prescriptions by mail. Mail-order prescriptions generally cost less than prescriptions filled at a local pharmacy.
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